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Organization
FAYETTEVILLE HEALTHCARE, LLC
Active
Organization
FAYETTEVILLE HEALTHCARE, LLC
Active
Other names
Fayetteville Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS D JOHNSON (CHIEF MANAGER)
(423) 478-5953
Entity
Organization
Contact information
Practice address
4081 THORNTON TAYLOR PKWY, FAYETTEVILLE, TN 37334-2674
(931) 433-9773
Mailing address
4081 THORNTON TAYLOR PKWY, FAYETTEVILLE, TN 37334-2674
(931) 433-9973
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445320
—
TN
05
—
7440356
—
TN
Enumeration date
09/19/2013
Last updated
03/28/2019
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