Healthcare Provider Details

I. General information

NPI: 1316242514
Provider Name (Legal Business Name): HENRY CO. HEALTH DEPT.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 JOY ST.
PARIS TN
38242
US

IV. Provider business mailing address

803 JOY ST.
PARIS TN
38242
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-4025
  • Fax: 731-644-0711
Mailing address:
  • Phone: 731-642-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLPN75880
License Number StateTN

VIII. Authorized Official

Name: LORI ANNE TAYLOR
Title or Position: NURSING SUPERVISOR
Credential:
Phone: 731-642-4025