Provider Demographics
NPI:1083609168
Name:BORDEAUX LONG TERM CARE
Entity Type:Organization
Organization Name:BORDEAUX LONG TERM CARE
Other - Org Name:BORDEAUX LONG-TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:615-341-4491
Mailing Address - Street 1:1414 COUNTY HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-3023
Mailing Address - Country:US
Mailing Address - Phone:615-862-7005
Mailing Address - Fax:615-862-6960
Practice Address - Street 1:1414 COUNTY HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-3023
Practice Address - Country:US
Practice Address - Phone:615-862-7005
Practice Address - Fax:615-862-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000063313M00000X, 314000000X
TN63314000000X
TN0175630001332B00000X, 332BP3500X
TN46463223336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454877Medicaid
TN4414330OtherPHARMACY
TN7440149Medicaid
TN0445033Medicaid
TN7440149Medicaid
TN0175630001Medicare NSC