Basic Information
| Provider Information | |||||||||
| NPI: | 1154907079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHURCH HILL TN OPCO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1449 37TH ST STE 605 | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112184382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466490478 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 W MAIN BLVD | ||||||||
| Address2: | |||||||||
| City: | CHURCH HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376423915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233577178 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2021 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | MOSKOWITZ | ||||||||
| AuthorizedOfficialFirstName: | ISAAC | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2124441991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.