Provider Demographics
NPI:1235301326
Name:GALLAWAY OPERATOR LLC
Entity Type:Organization
Organization Name:GALLAWAY OPERATOR LLC
Other - Org Name:GALLAWAY HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-895-1797
Mailing Address - Street 1:435 OLD BROWNSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:GALLAWAY
Mailing Address - State:TN
Mailing Address - Zip Code:38036-0000
Mailing Address - Country:US
Mailing Address - Phone:901-867-8575
Mailing Address - Fax:901-867-2598
Practice Address - Street 1:435 OLD BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:GALLAWAY
Practice Address - State:TN
Practice Address - Zip Code:38036-0000
Practice Address - Country:US
Practice Address - Phone:901-867-8575
Practice Address - Fax:901-867-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000077314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445440 (SNF)Medicaid
TN7440264 (ICF)Medicaid
TN0445440 (SNF)Medicaid