Provider Demographics
NPI:1013313865
Name:SHELBY COUNTY HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:SHELBY COUNTY HEALTH CARE CORPORATION
Other - Org Name:REGIONAL ONE HEALTH SUBACUTE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEROUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-515-4300
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:3RD FLOOR, ADAMS PAVILION
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:3RD FLOOR, ADAMS PAVILION
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-515-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN405314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
445521Medicare Oscar/Certification