Provider Demographics
NPI:1487858221
Name:PERRY COMMUNITY HOSPITAL, LLC
Entity Type:Organization
Organization Name:PERRY COMMUNITY HOSPITAL, LLC
Other - Org Name:PERRY COMMUNITY HOSPITAL GERIATRIC PSYCH UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-589-2121
Mailing Address - Street 1:2718 SQUIRREL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-3526
Mailing Address - Country:US
Mailing Address - Phone:913-589-2121
Mailing Address - Fax:931-589-3331
Practice Address - Street 1:2718 SQUIRREL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-3526
Practice Address - Country:US
Practice Address - Phone:913-589-2121
Practice Address - Fax:931-589-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000093273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440040Medicaid
TN0440040Medicaid