Healthcare Provider Details

I. General information

NPI: 1285155705
Provider Name (Legal Business Name): STONES RIVER MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HAYNES DR
MURFREESBORO TN
37129-5101
US

IV. Provider business mailing address

205 HAYNES DR
MURFREESBORO TN
37129-5101
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-5617
  • Fax: 615-895-0711
Mailing address:
  • Phone: 615-893-5617
  • Fax: 615-895-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. KIRKLAND A. MASON
Title or Position: CEO
Credential:
Phone: 615-893-5617