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NPI Code Detail

MEDICARE: ARDMORE HEALTHCARE, LLC

MEDICARE: ARDMORE HEALTHCARE, LLC
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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386070563
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARDMORE HEALTHCARE, LLC
Provider Business Mailing Address
First Line : 25385 MAIN ST
Second Line :
City : ARDMORE
State : TN
Zip : 38449-3155
Country : US
Telephone Number : 931-427-2143
Fax Number :
Provider Business Practice Location Address
First Line : 25385 MAIN ST
Second Line :
City : ARDMORE
State : TN
Zip : 38449-3155
Country : US
Telephone Number : 931-427-2143
Fax Number :
Authorized Official
Title or Position : CHIEF MANAGER
Name : THOMAS D JOHNSON
Credential :
Telephone Number : 423-478-5953
Provider Enumeration Date : 09/19/2013
Last Update Date : 03/28/2019

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Directions to “ARDMORE HEALTHCARE, LLC ” Practice Location

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