Healthcare Provider Details

I. General information

NPI: 1740319664
Provider Name (Legal Business Name): PORTLAND NURSING & REHAB CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HIGHLAND CIRCLE DR
PORTLAND TN
37148-4918
US

IV. Provider business mailing address

602 COURTLAND ST SUITE 200
ORLANDO FL
32804-1360
US

V. Phone/Fax

Practice location:
  • Phone: 615-325-9263
  • Fax: 615-325-5776
Mailing address:
  • Phone: 407-975-3000
  • Fax: 407-975-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000270
License Number StateTN

VIII. Authorized Official

Name: MR. DAVID RODMAN
Title or Position: ASST. SECRETARY
Credential:
Phone: 407-975-3011