Healthcare Provider Details

I. General information

NPI: 1962065953
Provider Name (Legal Business Name): SHELBYVILLE CENTER FOR NURSING AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GLENOAKS RD
SHELBYVILLE TN
37160-2529
US

IV. Provider business mailing address

1101 GLENOAKS RD
SHELBYVILLE TN
37160-2529
US

V. Phone/Fax

Practice location:
  • Phone: 931-684-8340
  • Fax: 931-684-4113
Mailing address:
  • Phone: 931-684-8340
  • Fax: 931-684-4113

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: AKIVA T GLATZER
Title or Position: MEMBER
Credential:
Phone: 718-879-3030