Provider Demographics
NPI:1013281161
Name:UPLANDS VILLAGE
Entity Type:Organization
Organization Name:UPLANDS VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-277-3518
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:2012-03-06
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000068310400000X
TN0000000028313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440128AMedicaid