Basic Information
| Provider Information | |||||||||
| NPI: | 1063977072 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TN MEM OP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 548 CEDARWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CEDARHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115161010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178041661 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3549 NORRISWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381115911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013257820 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2019 | ||||||||
| LastUpdateDate: | 02/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | LEIBOWITZ | ||||||||
| AuthorizedOfficialFirstName: | CHAIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9198041661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.