Provider Demographics
NPI:1578697751
Name:COUNTY OF OBION
Entity Type:Organization
Organization Name:COUNTY OF OBION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-885-9065
Mailing Address - Street 1:1084 E COUNTY HOME RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-8006
Mailing Address - Country:US
Mailing Address - Phone:731-885-9065
Mailing Address - Fax:731-885-0669
Practice Address - Street 1:1084 E COUNTY HOME RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-8006
Practice Address - Country:US
Practice Address - Phone:731-885-9065
Practice Address - Fax:731-885-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000196313M00000X
4445508314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440159Medicaid