Healthcare Provider Details

I. General information

NPI: 1871650895
Provider Name (Legal Business Name): MRH DBA WMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SOUTH HIGH STREET
WAYNESBORO TN
38485
US

IV. Provider business mailing address

103 JV MANGUBAT DRIVE
WAYNESBORO TN
38485
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-5832
  • Fax: 931-722-6522
Mailing address:
  • Phone: 931-722-3641
  • Fax: 931-722-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number277
License Number StateTN

VIII. Authorized Official

Name: CHARLES J BRINKLEY III
Title or Position: CFO
Credential:
Phone: 931-405-4212