Provider Demographics
NPI:1457676843
Name:UPLANDS RETIREMENT VILLAGE
Entity Type:Organization
Organization Name:UPLANDS RETIREMENT VILLAGE
Other - Org Name:ELIZABETH FLETCHER HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HIMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-277-3518
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38578-0168
Mailing Address - Country:US
Mailing Address - Phone:931-277-3518
Mailing Address - Fax:931-277-5396
Practice Address - Street 1:40 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:TN
Practice Address - Zip Code:38578-3001
Practice Address - Country:US
Practice Address - Phone:931-277-3523
Practice Address - Fax:931-277-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN68310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445236Medicaid