1104330430 NPI number — ENDURACARE ACUTE CARE SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104330430 NPI number — ENDURACARE ACUTE CARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDURACARE ACUTE CARE SERVICES 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:
1104330430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
381 RIVERSIDE DR STE 440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37064-8934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-861-8755
Provider Business Mailing Address Fax Number:
615-472-1936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7381 S SIWELL RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BYRAM
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39272-8741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-373-2075
Provider Business Practice Location Address Fax Number:
601-373-2077
Provider Enumeration Date:
11/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BERRELL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP OF HUMAN RESOURCES
Authorized Official Telephone Number:
615-861-8755

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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