Basic Information
| Provider Information | |||||||||
| NPI: | 1831344233 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HIGHLANDS OF MEMPHIS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE HIGHLANDS OF MEMPHIS HEALTH & REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3549 NORRISWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381115911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013257820 | ||||||||
| FaxNumber: | 9014521573 | ||||||||
| Practice Location | |||||||||
| Address1: | 3549 NORRISWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381115911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013257820 | ||||||||
| FaxNumber: | 9014521573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2008 | ||||||||
| LastUpdateDate: | 12/02/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BARNETT | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | DENNY | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4439045200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 00000257 | TN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.