Healthcare Provider Details

I. General information

NPI: 1881749596
Provider Name (Legal Business Name): HUMPHREYS COUNTY CARE AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FORT HILL RD
WAVERLY TN
37185-2128
US

IV. Provider business mailing address

104 FORT HILL RD
WAVERLY TN
37185-2128
US

V. Phone/Fax

Practice location:
  • Phone: 931-296-2532
  • Fax: 931-296-0829
Mailing address:
  • Phone: 931-296-2532
  • Fax: 931-296-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0135
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0000000135
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000135
License Number StateTN

VIII. Authorized Official

Name: MR. RODERICK D WOLFE
Title or Position: ADMINISTRATOR
Credential:
Phone: 931-296-2532