MEDICARE: LEBANON CENTER FOR REHABILITATION AND HEALING 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1497312706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEBANON CENTER FOR REHABILITATION AND HEALING LLC

Provider Business Mailing Address
First Line	:	731 CASTLE HEIGHTS CT
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2646
Country	:	US
Telephone Number	:	615-444-4319
Fax Number	:	615-444-4393

Provider Business Practice Location Address
First Line	:	731 CASTLE HEIGHTS CT
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2646
Country	:	US
Telephone Number	:	615-444-4319
Fax Number	:	615-444-4393

Authorized Official
Title or Position	:	MANAGER
Name	:	MARK FRIEDMAN
Credential	:
Telephone Number	:	201-731-1700

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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