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NPI Code Detail

MEDICARE: FMSC COLLIERVILLE OPERATING COMPANY LLC

MEDICARE: FMSC COLLIERVILLE OPERATING COMPANY 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 Facility236TN

General Provider Information

NPI Number : 1386693265
Entity Type Code : Organization
Provider Name (Legal Business Name) : FMSC COLLIERVILLE OPERATING COMPANY LLC
Provider Business Mailing Address
First Line : 490 W POPLAR AVE
Second Line :
City : COLLIERVILLE
State : TN
Zip : 38017-2538
Country : US
Telephone Number : 901-853-8561
Fax Number : 901-853-1341
Provider Business Practice Location Address
First Line : 490 W POPLAR AVE
Second Line :
City : COLLIERVILLE
State : TN
Zip : 38017-2538
Country : US
Telephone Number : 901-853-8561
Fax Number : 901-853-1341
Authorized Official
Title or Position : VICE PRESIDENT OF OPERATIONS
Name : MR. DENNIS SARCAUGA
Credential :
Telephone Number : 305-892-1790
Provider Enumeration Date : 05/09/2006
Last Update Date : 08/22/2020

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Directions to “FMSC COLLIERVILLE OPERATING COMPANY LLC ” Practice Location

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