# WAYNESBORO HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waynesboro Health and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235543463
- **Authorized official:** MR. KENNETH C HART JR. (TREASURER)
- **Authorized official phone:** (423) 584-6755

## Contact information

- **Practice address:** 104 JV MANGUBAT DR, WAYNESBORO, TN 38485-2439
- **Practice address phone:** (931) 722-3641
- **Mailing address:** 104 JV MANGUBAT DR, WAYNESBORO, TN 38485-2439
- **Mailing address phone:** (931) 722-3641
- **Mailing address fax:** (931) 722-7215

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 0000000278 | TN | Yes |

## Other

- **Enumeration date:** 06/16/2014
- **Last updated:** 03/28/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0445518 | — | TN |
| 05 | — | 7440620 | — | TN |