Provider Demographics
NPI:1790786614
Name:OVERTON COUNTY HEALTH AND REHAB CENTER
Entity Type:Organization
Organization Name:OVERTON COUNTY HEALTH AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:931-823-6403
Mailing Address - Street 1:318 BILBREY ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1706
Mailing Address - Country:US
Mailing Address - Phone:931-823-6403
Mailing Address - Fax:931-823-7836
Practice Address - Street 1:318 BILBREY ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1706
Practice Address - Country:US
Practice Address - Phone:931-823-6403
Practice Address - Fax:931-823-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000200313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445419Medicaid
TN106838OtherSKILLED NURSING FACILITY
TN7440219Medicaid
TN0445419Medicaid