Basic Information
| Provider Information | |||||||||
| NPI: | 1376548743 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VANGUARD OF CHURCH HILL, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHURCH HILL HEALTH CARE & REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9020 OVERLOOK BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370272755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152507100 | ||||||||
| FaxNumber: | 6152507101 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 W MAIN BLVD | ||||||||
| Address2: | |||||||||
| City: | CHURCH HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233577178 | ||||||||
| FaxNumber: | 4233575857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | ORAND | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6152507100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0000000125 | TN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 7440497 | 05 | TN | MEDICAID | 0445237 | 05 | TN | MEDICAID |