Provider Demographics
NPI:1790197945
Name:REGIONAL MED EXTENDED CARE HOSPITAL, LLC
Entity Type:Organization
Organization Name:REGIONAL MED EXTENDED CARE HOSPITAL, LLC
Other - Org Name:REGIONAL ONE HEALTH EXTENDED CARE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-515-3030
Mailing Address - Street 1:890 MADISON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3409
Mailing Address - Country:US
Mailing Address - Phone:901-515-3000
Mailing Address - Fax:
Practice Address - Street 1:890 MADISON AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3409
Practice Address - Country:US
Practice Address - Phone:901-515-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN186282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
442017Medicare Oscar/Certification