=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114953635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENET HEALTHSYSTEM SF-SNF
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 06/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5959 PARK AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38119-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-765-3110
-----------------------------------------------------
Fax | 901-765-3106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5959 PARK AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38119-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-765-3110
-----------------------------------------------------
Fax | 901-765-3106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF TAXATION, TENET HEALTHCARE
-----------------------------------------------------
Name | MR. DOUGLAS E. RABE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-893-2530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 254
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------