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General NPI Number Information
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NPI Number | 1992119010
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Entity Type | Organization
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Legal Business Name | WAYNESBORO HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 505 S HIGH ST
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City | WAYNESBORO
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State | TN
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Zip | 38485-2610
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Country | US
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Telephone | 931-722-5832
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Fax | 931-722-6522
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Provider Business Mailing Address
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Address Line | 485 CENTRAL AVE NE
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City | CLEVELAND
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State | TN
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Zip | 37311-5541
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Country | US
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Telephone | 423-478-5953
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Fax | 423-472-6283
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Authorized Official
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Title or Position | TREASURER
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Name | MR. KENNETH C HART JR.
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Credential |
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Telephone | 423-584-6755
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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 | 0000000277
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License Number State | TN
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