# CORDOVA HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRACE HEALTHCARE OF CORDOVA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629258546
- **Authorized official:** MR. CRAIG D. TAYLOR (CHIEF MANAGER)
- **Authorized official phone:** (423) 308-1845

## Contact information

- **Practice address:** 955 N GERMANTOWN PKWY, CORDOVA, TN 38018-6215
- **Practice address phone:** (901) 754-1393
- **Practice address fax:** (336) 433-7468
- **Mailing address:** 955 N GERMANTOWN PKWY, CORDOVA, TN 38018-6215
- **Mailing address phone:** (901) 754-1393
- **Mailing address fax:** (336) 433-7468

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 0000000238 | TN | Yes |

## Other

- **Enumeration date:** 11/08/2007
- **Last updated:** 10/30/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0445218 | — | TN |
| 05 | — | 7440486 | — | TN |