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General NPI Number Information
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NPI Number | 1538156575
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Entity Type | Organization
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Legal Business Name | WAYNE COUNTY NURSING HOME
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 104 JV MANGUBAT DR
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City | WAYNESBORO
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State | TN
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Zip | 38485-2439
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Country | US
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Telephone | 931-722-3641
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Fax | 931-722-7215
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Provider Business Mailing Address
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Address Line | PO BOX 510
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City | WAYNESBORO
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State | TN
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Zip | 38485-0510
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Country | US
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Telephone | 931-722-3641
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Fax | 931-722-7215
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ALICE FAYE WRIGHT
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Credential | LIC ADMINISTRATOR ST
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Telephone | 931-722-3641
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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 | 0000000278
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License Number State | TN
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