Provider Demographics
NPI:1558499483
Name:PERRY COMMUNITY HOSPITAL, LLC
Entity type:Organization
Organization Name:PERRY COMMUNITY HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-589-2121
Mailing Address - Street 1:2718 SQUIRREL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-3526
Mailing Address - Country:US
Mailing Address - Phone:931-589-2121
Mailing Address - Fax:931-589-3331
Practice Address - Street 1:2718 SQUIRREL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3526
Practice Address - Country:US
Practice Address - Phone:931-589-2121
Practice Address - Fax:931-589-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000093273R00000X, 275N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440040Medicaid
TN0440040Medicaid
TN44S040Medicare ID - Type UnspecifiedGERIATRIC PSYCH
TN44U040Medicare Oscar/Certification
TN440040Medicare ID - Type Unspecified