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General NPI Number Information
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NPI Number | 1194702902
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Entity Type | Organization
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Legal Business Name | MILLINGTON OPCO LP
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 5081 EASLEY ST
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City | MILLINGTON
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State | TN
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Zip | 38053-2105
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Country | US
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Telephone | 901-873-3290
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Fax | 901-873-0531
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Provider Business Mailing Address
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Address Line | 5081 EASLEY ST
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City | MILLINGTON
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State | TN
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Zip | 38053-2105
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Country | US
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Telephone | 901-873-3290
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Fax | 901-873-0531
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Authorized Official
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Title or Position | CEO
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Name | MOSHE KELMAN
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Credential |
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Telephone | 786-987-3707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0000000316
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License Number State | TN
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