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Organization
EXTENDICARE OF WEST TENN
Active
Organization
EXTENDICARE OF WEST TENN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARSHA D KELLY RN (CEO)
(731) 668-1372
Entity
Organization
Contact information
Practice address
90 DIRECTORS ROW, JACKSON, TN 38305-2345
(731) 668-1372
(731) 664-9919
Mailing address
90 DIRECTORS ROW, P O BOX 3482, JACKSON, TN 38305-2345
(731) 668-1372
(731) 664-9919
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
0000000120
TN
Other
Enumeration date
09/07/2005
Last updated
08/22/2020
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