Provider Demographics
NPI:1194032524
Name:UNION CITY RESCARE
Entity Type:Organization
Organization Name:UNION CITY RESCARE
Other - Org Name:MAGNOLIA PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-885-8004
Mailing Address - Street 1:1620 N CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-1813
Mailing Address - Country:US
Mailing Address - Phone:731-885-8004
Mailing Address - Fax:731-885-2171
Practice Address - Street 1:1620 N CLOVER ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-1813
Practice Address - Country:US
Practice Address - Phone:731-885-8004
Practice Address - Fax:731-885-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0234310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility