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General NPI Number Information
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NPI Number | 1417280249
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Entity Type | Organization
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Legal Business Name | JACKSON PARK CHRISTIAN HOME, INC.
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 4107 GALLATIN PIKE
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City | NASHVILLE
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State | TN
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Zip | 37216-2109
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Country | US
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Telephone | 615-228-0356
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Fax | 615-228-3021
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Provider Business Mailing Address
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Address Line | 4107 GALLATIN PIKE
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City | NASHVILLE
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State | TN
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Zip | 37216-2109
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Country | US
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Telephone | 615-228-0356
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Fax | 615-228-3021
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PATRICIA GAMMEL
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Credential |
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Telephone | 615-228-0356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0000000055
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License Number State | TN
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