=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356368294
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORRIS SNF MANAGEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2006
-----------------------------------------------------
Last Update Date | 08/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1095 TWILIGHT DRIVE
-----------------------------------------------------
City | MORRIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60450-3322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-942-5108
-----------------------------------------------------
Fax | 815-942-6877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1667
-----------------------------------------------------
City | HICKORY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28603-1667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-324-8898
-----------------------------------------------------
Fax | 828-322-9598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. STEVEN D WOMACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-381-5360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 0050468
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------