MEDICARE: MURFREESBORO NURSING CENTER, 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	313M00000X	Nursing Facility/Intermediate Care Facility	548	AR

General Provider Information

NPI Number	:	1528014487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURFREESBORO NURSING CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 656
Second Line	:
City	:	MURFREESBORO
State	:	AR
Zip	:	71958-0656
Country	:	US
Telephone Number	:	870-285-2186
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 W 13TH ST
Second Line	:
City	:	MURFREESBORO
State	:	AR
Zip	:	71958-9501
Country	:	US
Telephone Number	:	870-285-2186
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROGER DALE TIDWELL
Credential	:
Telephone Number	:	870-285-2186

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	02/22/2008

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