Basic Information
| Provider Information | |||||||||
| NPI: | 1407499254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOULEVARD TERRACE HEALTHCARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 CHESTNUT STREET | ||||||||
| Address2: | |||||||||
| City: | CEDARHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3476770448 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1530 MIDDLE TENNESSEE BLVD | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158964505 | ||||||||
| FaxNumber: | 6158958544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2019 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | GOLDNER | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3476770448 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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.