MEDICARE: VANGUARD OF ASHLAND, 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	677	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1609855154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANGUARD OF ASHLAND, LLC

Provider Business Mailing Address
First Line	:	9020 OVERLOOK BLVD STE 202
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2755
Country	:	US
Telephone Number	:	615-250-7100
Fax Number	:	615-250-7102

Provider Business Practice Location Address
First Line	:	16056 BOUNDARY DR
Second Line	:
City	:	ASHLAND
State	:	MS
Zip	:	38603
Country	:	US
Telephone Number	:	662-224-6196
Fax Number	:	662-224-6899

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFI
Name	:	MR. WILLIAM D. ORAND
Credential	:
Telephone Number	:	615-250-7100

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	05/24/2018

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