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General NPI Number Information
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NPI Number | 1396724845
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Entity Type | Organization
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Legal Business Name | VANGUARD OF CRESTVIEW, LLC
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 2030 25TH AVE N
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City | NASHVILLE
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State | TN
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Zip | 37208
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Country | US
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Telephone | 615-256-4697
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Fax | 615-256-4616
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Provider Business Mailing Address
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Address Line | 9020 OVERLOOK BLVD STE 202
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City | BRENTWOOD
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State | TN
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Zip | 37027-2755
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Country | US
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Telephone | 615-250-7100
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Fax | 615-250-7101
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM D ORAND
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Credential |
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Telephone | 615-250-7100
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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 | 0000000047
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License Number State | TN
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