Healthcare Provider Details

I. General information

NPI: 1407388580
Provider Name (Legal Business Name): SKYLINE OF MEMPHIS HEALTHCARE AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 NORRISWOOD AVE
MEMPHIS TN
38111-5911
US

IV. Provider business mailing address

3549 NORRISWOOD AVE
MEMPHIS TN
38111-5911
US

V. Phone/Fax

Practice location:
  • Phone: 901-325-7820
  • Fax: 901-452-1573
Mailing address:
  • Phone: 901-325-7820
  • Fax: 901-452-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTN

VIII. Authorized Official

Name: SCOTT E BROWN
Title or Position: MANAGER
Credential:
Phone: 770-754-9660