Cordova Healthcare, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000238 Issued in TN

Legal business name

CORDOVA HEALTHCARE, LLC

Doing business as

Grace Healthcare of Cordova

Practice address

955 N Germantown Pkwy
Cordova, TN 38018-6215

Phone

(901) 754-1393

Fax

(336) 433-7468

NPI assigned

Nov 8, 2007

Last updated

Oct 30, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Craig D. Taylor

Title

Chief Manager

Phone

(423) 308-1845

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• GRACE HEALTHCARE OF CORDOVA Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1629258546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 N GERMANTOWN PKWY",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186215",
            "telephone_number": "901-754-1393",
            "fax_number": "336-433-7468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 N GERMANTOWN PKWY",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186215",
            "telephone_number": "901-754-1393",
            "fax_number": "336-433-7468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORDOVA HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF MANAGER",
        "authorized_official_telephone_number": "423-308-1845",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440486",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445218",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRACE HEALTHCARE OF CORDOVA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Cordova, TN
• Providers in Cordova, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.