MEDICARE: BORDEAUX LONG TERM CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	4646322	TN
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	0175630001	TN
3	332B00000X	Durable Medical Equipment & Medical Supplies	0175630001	TN
4	314000000X	Skilled Nursing Facility	0000000063	TN
5	313M00000X	Nursing Facility/Intermediate Care Facility	0000000063	TN
6	314000000X	Skilled Nursing Facility	63	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4414330	OTHER	TN	PHARMACY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083609168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORDEAUX LONG TERM CARE

Provider Business Mailing Address
First Line	:	1414 COUNTY HOSPITAL RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37218-3023
Country	:	US
Telephone Number	:	615-862-7005
Fax Number	:	615-862-6960

Provider Business Practice Location Address
First Line	:	1414 COUNTY HOSPITAL RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37218-3023
Country	:	US
Telephone Number	:	615-862-7005
Fax Number	:	615-862-6960

Authorized Official
Title or Position	:	INTERIM CEO
Name	:	MR. JASON BOYD
Credential	:	FACHE
Telephone Number	:	615-341-4491

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	06/03/2013

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Directions to “BORDEAUX LONG TERM CARE ” Practice Location

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