Provider Demographics
NPI:1013683515
Name:CD-TT CORDOVA, LLC
Entity Type:Organization
Organization Name:CD-TT CORDOVA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-492-5002
Mailing Address - Street 1:1600 APPLING RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4906
Mailing Address - Country:US
Mailing Address - Phone:901-250-1195
Mailing Address - Fax:901-250-1192
Practice Address - Street 1:1600 APPLING RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4906
Practice Address - Country:US
Practice Address - Phone:901-250-1195
Practice Address - Fax:901-250-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility