# BLAKEFORD AT GREEN HILLS CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053301556
- **Authorized official:** MR. VAN A CLUCK (CEO)
- **Authorized official phone:** (615) 665-9505

## Contact information

- **Practice address:** 11 BURTON HILLS BLVD, NASHVILLE, TN 37215-6138
- **Practice address phone:** (615) 665-9505
- **Practice address fax:** (615) 665-0579
- **Mailing address:** 11 BURTON HILLS BLVD, NASHVILLE, TN 37215-6138
- **Mailing address phone:** (615) 665-9505
- **Mailing address fax:** (615) 665-0579

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 343 | TN | Yes |

## Other

- **Enumeration date:** 10/26/2005
- **Last updated:** 01/06/2012