Provider Demographics
NPI:1164565206
Name:BUFFALO RIVER HEALTHCARE LLC
Entity Type:Organization
Organization Name:BUFFALO RIVER HEALTHCARE LLC
Other - Org Name:PERRY COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:931-589-2134
Mailing Address - Street 1:127 EAST BROOKLYN AVENUE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-3515
Mailing Address - Country:US
Mailing Address - Phone:931-589-2134
Mailing Address - Fax:931-589-3847
Practice Address - Street 1:127 EAST BROOKLYN AVENUE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3515
Practice Address - Country:US
Practice Address - Phone:931-589-2134
Practice Address - Fax:931-589-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000201313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440536Medicaid