Healthcare Provider Details

I. General information

NPI: 1083609168
Provider Name (Legal Business Name): BORDEAUX LONG TERM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 COUNTY HOSPITAL RD
NASHVILLE TN
37218-3023
US

IV. Provider business mailing address

1414 COUNTY HOSPITAL RD
NASHVILLE TN
37218-3023
US

V. Phone/Fax

Practice location:
  • Phone: 615-862-7005
  • Fax: 615-862-6960
Mailing address:
  • Phone: 615-862-7005
  • Fax: 615-862-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0000000063
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000063
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number63
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0175630001
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0175630001
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number4646322
License Number StateTN

VIII. Authorized Official

Name: MR. JASON BOYD
Title or Position: INTERIM CEO
Credential: FACHE
Phone: 615-341-4491