Provider Demographics
NPI:1386693265
Name:FMSC COLLIERVILLE OPERATING COMPANY LLC
Entity type:Organization
Organization Name:FMSC COLLIERVILLE OPERATING COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SARCAUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-892-1790
Mailing Address - Street 1:490 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2538
Mailing Address - Country:US
Mailing Address - Phone:901-853-8561
Mailing Address - Fax:901-853-1341
Practice Address - Street 1:490 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2538
Practice Address - Country:US
Practice Address - Phone:901-853-8561
Practice Address - Fax:901-853-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN236314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44-5282Medicare ID - Type Unspecified