Provider Demographics
NPI:1699716639
Name:HENRY COUNTY HEALTHCARE CENTER
Entity type:Organization
Organization Name:HENRY COUNTY HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-644-8912
Mailing Address - Street 1:239 HOSPITAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-0000
Mailing Address - Country:US
Mailing Address - Phone:731-642-5700
Mailing Address - Fax:731-644-8999
Practice Address - Street 1:239 HOSPITAL CIRCLE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-0000
Practice Address - Country:US
Practice Address - Phone:731-642-5700
Practice Address - Fax:731-644-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000128314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
93339OtherBLUE CROSS
TN0445224Medicaid
TN7440088Medicaid
TN0445224Medicaid
TN0445224Medicaid
TN445224Medicare ID - Type Unspecified