Healthcare Provider Details

I. General information

NPI: 1417936840
Provider Name (Legal Business Name): VANGUARD OF MEMPHIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N TUCKER ST
MEMPHIS TN
38104
US

IV. Provider business mailing address

9020 OVERLOOK BLVD STE 202
BRENTWOOD TN
37027-2755
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-5600
  • Fax: 901-255-1359
Mailing address:
  • Phone: 615-250-7100
  • Fax: 615-250-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000240
License Number StateTN

VIII. Authorized Official

Name: MR. WILLIAM D ORAND
Title or Position: CEO
Credential:
Phone: 615-250-7100