Basic Information
Provider Information | |||||||||
NPI: | 1508370834 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ENDURACARE ACUTE CARE SERVICES LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ENDURACARE ACUTE CARE SERVICES MADISON | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 381 RIVERSIDE DR STE 440 | ||||||||
Address2: |   | ||||||||
City: | FRANKLIN | ||||||||
State: | TN | ||||||||
PostalCode: | 370648934 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6158618755 | ||||||||
FaxNumber: | 6154721936 | ||||||||
Practice Location | |||||||||
Address1: | 1 WOODGREEN PL STE 101 | ||||||||
Address2: |   | ||||||||
City: | MADISON | ||||||||
State: | MS | ||||||||
PostalCode: | 391108161 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6016051126 | ||||||||
FaxNumber: | 6016051891 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/22/2017 | ||||||||
LastUpdateDate: | 11/22/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BERRELL | ||||||||
AuthorizedOfficialFirstName: | JENNIFER | ||||||||
AuthorizedOfficialMiddleName: | C | ||||||||
AuthorizedOfficialTitleorPosition: | VP OF HUMAN RESOURCES | ||||||||
AuthorizedOfficialTelephone: | 6158618755 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.