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General NPI Number Information
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NPI Number | 1861664955
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Entity Type | Organization
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Legal Business Name | REELFOOT OPERATOR LLC
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 1034 REELFOOT ST
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City | TIPTONVILLE
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State | TN
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Zip | 38079-1607
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Country | US
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Telephone | 731-253-6681
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Fax | 731-253-8014
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Provider Business Mailing Address
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Address Line | 1034 REELFOOT ST
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City | TIPTONVILLE
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State | TN
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Zip | 38079-1607
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Country | US
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Telephone | 731-253-6681
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Fax | 731-253-8014
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LORI A. CHAMBERS
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Credential |
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Telephone | 731-253-6681
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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 | 0000000151
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License Number State | TN
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