Healthcare Provider Details

I. General information

NPI: 1508866898
Provider Name (Legal Business Name): COMMUNITY CARE OF RUTHERFORD COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901EAST COUNTY FARM RD
MURFREESBORO TN
37127-6328
US

IV. Provider business mailing address

901 EAST COUNTY FARM RD
MURFREESBORO TN
37127-6328
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-2624
  • Fax: 615-898-7989
Mailing address:
  • Phone: 615-893-2624
  • Fax: 615-898-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000219
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateTN

VIII. Authorized Official

Name: MARK KING
Title or Position: ADMINISTRATOR
Credential:
Phone: 615-893-2624