Provider Demographics
NPI:1669469805
Name:EDGEFIELD REHABILITATION, LLC
Entity Type:Organization
Organization Name:EDGEFIELD REHABILITATION, LLC
Other - Org Name:NASHVILLE REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-226-4330
Mailing Address - Street 1:610 GALLATIN AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3225
Mailing Address - Country:US
Mailing Address - Phone:615-226-4330
Mailing Address - Fax:615-650-2565
Practice Address - Street 1:610 GALLATIN AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3225
Practice Address - Country:US
Practice Address - Phone:615-226-4330
Practice Address - Fax:615-650-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440026Medicaid
TN3250125Medicare ID - Type UnspecifiedGROUP PRICING # PT. B
TN440026Medicare Oscar/Certification