Provider Demographics
NPI:1265414429
Name:B'NAI B'RITH HOME & HOSPITAL FOR THE AGED, INC.
Entity type:Organization
Organization Name:B'NAI B'RITH HOME & HOSPITAL FOR THE AGED, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:III
Authorized Official - Credentials:LNHA
Authorized Official - Phone:901-758-0036
Mailing Address - Street 1:36 BAZEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7754
Mailing Address - Country:US
Mailing Address - Phone:901-758-0036
Mailing Address - Fax:
Practice Address - Street 1:36 BAZEBERRY RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7754
Practice Address - Country:US
Practice Address - Phone:901-758-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440553Medicaid
TN445293Medicare ID - Type Unspecified