Healthcare Provider Details

I. General information

NPI: 1053301556
Provider Name (Legal Business Name): BLAKEFORD AT GREEN HILLS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BURTON HILLS BLVD
NASHVILLE TN
37215-6138
US

IV. Provider business mailing address

11 BURTON HILLS BLVD
NASHVILLE TN
37215-6138
US

V. Phone/Fax

Practice location:
  • Phone: 615-665-9505
  • Fax: 615-665-0579
Mailing address:
  • Phone: 615-665-9505
  • Fax: 615-665-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number343
License Number StateTN

VIII. Authorized Official

Name: MR. VAN A CLUCK
Title or Position: CEO
Credential:
Phone: 615-665-9505