Healthcare Provider Details

I. General information

NPI: 1992530232
Provider Name (Legal Business Name): LACEFIELD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 FLORENCE RD
SAVANNAH TN
38372-5210
US

IV. Provider business mailing address

1645 FLORENCE RD
SAVANNAH TN
38372-5210
US

V. Phone/Fax

Practice location:
  • Phone: 731-926-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249