Provider Demographics
NPI:1508866898
Name:COMMUNITY CARE OF RUTHERFORD COUNTY, INC.
Entity Type:Organization
Organization Name:COMMUNITY CARE OF RUTHERFORD COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-893-2624
Mailing Address - Street 1:901 EAST COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-6328
Mailing Address - Country:US
Mailing Address - Phone:615-893-2624
Mailing Address - Fax:615-898-7989
Practice Address - Street 1:901EAST COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-6328
Practice Address - Country:US
Practice Address - Phone:615-893-2624
Practice Address - Fax:615-898-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000219314000000X
TN332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440175Medicaid
TN0445406Medicaid
TN4100484OtherBLUECROSS ALLIED PROVIDER
TN3110468OtherBLUE CROSS BLUE SHIELD
TN7440175Medicaid
TN4129050001Medicare NSC