Healthcare Provider Details

I. General information

NPI: 1831344233
Provider Name (Legal Business Name): HIGHLANDS OF MEMPHIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 12/02/2008
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 Number00000257
License Number StateTN

VIII. Authorized Official

Name: MR. ROBERT DENNY BARNETT
Title or Position: MANAGER
Credential:
Phone: 443-904-5200