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General NPI Number Information
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NPI Number | 1467417238
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Entity Type | Organization
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Legal Business Name | DYERSBURG NURSING AND REHABILITATION LLC
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 1900 PARR AVE
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 731-286-1221
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Fax | 731-285-3886
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | PARSONS
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State | TN
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Zip | 38363-0010
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Country | US
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Telephone | 731-847-6343
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Fax | 731-847-4200
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Authorized Official
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Title or Position | SECRETARY
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Name | MS. ROBIN F BRADLEY
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Credential |
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Telephone | 615-595-8383
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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 | 0074
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0000000074
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License Number State | TN
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