Provider Demographics
NPI:1295350510
Name:MCMINNVILLE TN OPCO LLC
Entity type:Organization
Organization Name:MCMINNVILLE TN OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VUJANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-667-8150
Mailing Address - Street 1:2100 CHEROKEE RIDGE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1600
Mailing Address - Country:US
Mailing Address - Phone:502-667-8150
Mailing Address - Fax:
Practice Address - Street 1:415 PACE ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1246
Practice Address - Country:US
Practice Address - Phone:931-668-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care