=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518404607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TREVECCA CENTER FOR REHABILITATION AND HEALING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2017
-----------------------------------------------------
Last Update Date | 08/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 329 MURFREESBORO PIKE
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37210-2834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-244-6900
-----------------------------------------------------
Fax | 615-255-1893
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 329 MURFREESBORO PIKE
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37210-2834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-244-6900
-----------------------------------------------------
Fax | 615-255-1893
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MARK FRIEDMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-731-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------