Provider Demographics
NPI:1669564803
Name:HICKMAN COMMUNITY HEALTH SERVICES
Entity type:Organization
Organization Name:HICKMAN COMMUNITY HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-284-6845
Mailing Address - Street 1:135 E SWAN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1417
Mailing Address - Country:US
Mailing Address - Phone:931-729-3513
Mailing Address - Fax:931-729-4612
Practice Address - Street 1:135 E SWAN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1417
Practice Address - Country:US
Practice Address - Phone:931-729-3513
Practice Address - Fax:931-729-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000132313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440462Medicaid