Healthcare Provider Details

I. General information

NPI: 1669469805
Provider Name (Legal Business Name): EDGEFIELD REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GALLATIN AVE
NASHVILLE TN
37206-3225
US

IV. Provider business mailing address

610 GALLATIN AVE
NASHVILLE TN
37206-3225
US

V. Phone/Fax

Practice location:
  • Phone: 615-226-4330
  • Fax: 615-650-2565
Mailing address:
  • Phone: 615-226-4330
  • Fax: 615-650-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number34
License Number StateTN

VIII. Authorized Official

Name: MR. BARTON HUDDLESTON
Title or Position: CEO/MEDICAL DIRECTOR
Credential: M.D.
Phone: 615-226-4330