Provider Demographics
NPI:1023065893
Name:THE VILLAGE AT GERMANTOWN INC
Entity type:Organization
Organization Name:THE VILLAGE AT GERMANTOWN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-752-2524
Mailing Address - Street 1:7820 WALKING HORSE CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2100
Mailing Address - Country:US
Mailing Address - Phone:901-752-2524
Mailing Address - Fax:901-752-2598
Practice Address - Street 1:7820 WALKING HORSE CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2100
Practice Address - Country:US
Practice Address - Phone:901-752-2524
Practice Address - Fax:901-752-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN445482Medicare PIN