Basic Information
| Provider Information | |||||||||
| NPI: | 1548303704 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLANDS OF MEMPHIS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIGHLANDS OF MEMPHIS HEALTH & REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 485 CENTRAL AVENUE NE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234785953 | ||||||||
| FaxNumber: | 4234726283 | ||||||||
| Practice Location | |||||||||
| Address1: | 3549 NORRISWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013257820 | ||||||||
| FaxNumber: | 9014521573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 05/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | BARNETT | ||||||||
| AuthorizedOfficialFirstName: | DENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4234785953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 0000000257 | TN | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | 0257 | TN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 7440266 | 05 | TN | MEDICAID |