1356368294 NPI number — MORRIS SNF MANAGEMENT, LLC

Table of content: (NPI 1356368294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356368294 NPI number — MORRIS SNF MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS SNF MANAGEMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356368294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28603-1667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-324-8898
Provider Business Mailing Address Fax Number:
828-322-9598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1095 TWILIGHT DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60450-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-942-5108
Provider Business Practice Location Address Fax Number:
815-942-6877
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOMACK
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
828-381-5360

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0050468 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0050468 . This is a "IL STATE LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6011381 . This is a "IDPH FACILITY NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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