=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245277110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NHC HEALTHCARE-SMITHVILLE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 03/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 FISHER AVE
-----------------------------------------------------
City | SMITHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37166-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-597-4284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 825 FISHER AVE
-----------------------------------------------------
City | SMITHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37166-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-597-4284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OF LLC
-----------------------------------------------------
Name | GREGORY G BIDWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-893-2602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 071
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------