Provider Demographics
NPI:1871637934
Name:UPLANDS VILLAGE
Entity Type:Organization
Organization Name:UPLANDS VILLAGE
Other - Org Name:WHARTON NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERSCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-277-1190
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38578-0168
Mailing Address - Country:US
Mailing Address - Phone:931-277-3518
Mailing Address - Fax:931-277-5396
Practice Address - Street 1:878-880 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:TN
Practice Address - Zip Code:38578
Practice Address - Country:US
Practice Address - Phone:931-277-3511
Practice Address - Fax:931-277-5519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPLANDS VILLAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440128Medicaid
TN3649Medicaid
TN44E208Medicaid
TN744-0128Medicaid