# FMSC COLLIERVILLE OPERATING COMPANY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Collierville Health & Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477525905
- **Authorized official:** MR. THEODORE M DUAY III C.P.A. (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (786) 888-3310

## Contact information

- **Practice address:** 490 W POPLAR AVE, COLLIERVILLE, TN 38017-2538
- **Practice address phone:** (305) 892-1790
- **Mailing address:** 1055 NE 125TH ST, NORTH MIAMI, FL 33161-5804
- **Mailing address phone:** (786) 888-3310

## Taxonomy

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

## Other

- **Enumeration date:** 02/07/2006
- **Last updated:** 12/03/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 744-0470 | — | TN |