Organization
BLACK WOLF HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOON BURNAM (TREASURER)
(949) 540-1249
Entity
Organization
Contact information
Practice address
524 W MAIN ST, DECATURVILLE, TN 38329-8101
(731) 852-3591
Mailing address
524 W MAIN ST, DECATURVILLE, TN 38329-8101
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
09/05/2024
Last updated
11/14/2025
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