Organization
ST PETER VILLA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAE WERHOVEN (ADMINISTRATOR)
(901) 276-2021
Entity
Organization
Contact information
Practice address
141 N MCLEAN BLVD, MEMPHIS, TN 38104-2693
(901) 276-2021
(901) 725-3564
Mailing address
141 N MCLEAN BLVD, MEMPHIS, TN 38104-2693
(901) 276-2021
(901) 725-3564
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
255
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7440447
—
TN
Enumeration date
10/26/2005
Last updated
08/22/2020
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