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NPI Code Detail

MEDICARE: WAYNE COUNTY NURSING HOME

MEDICARE: WAYNE COUNTY NURSING HOME
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
1313M00000XNursing Facility/Intermediate Care Facility0000000278TN

Other Identifiers

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

General Provider Information

NPI Number : 1538156575
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAYNE COUNTY NURSING HOME
Provider Business Mailing Address
First Line : PO BOX 510
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-0510
Country : US
Telephone Number : 931-722-3641
Fax Number : 931-722-7215
Provider Business Practice Location Address
First Line : 104 JV MANGUBAT DR
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-2439
Country : US
Telephone Number : 931-722-3641
Fax Number : 931-722-7215
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. ALICE FAYE WRIGHT
Credential : LIC ADMINISTRATOR ST
Telephone Number : 931-722-3641
Provider Enumeration Date : 10/04/2005
Last Update Date : 04/16/2008

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Directions to “WAYNE COUNTY NURSING HOME ” Practice Location

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