Provider Demographics
NPI:1821302431
Name:MURFREESBORO REHAB AND NURSING INC.
Entity Type:Organization
Organization Name:MURFREESBORO REHAB AND NURSING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-285-2186
Mailing Address - Street 1:110 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:71958-9501
Mailing Address - Country:US
Mailing Address - Phone:870-285-2186
Mailing Address - Fax:870-285-2348
Practice Address - Street 1:110 W 13TH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:AR
Practice Address - Zip Code:71958-9501
Practice Address - Country:US
Practice Address - Phone:870-285-2186
Practice Address - Fax:870-285-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182413311Medicaid
AR045415OtherMEDICARE ID#