Provider Demographics
NPI:1538156575
Name:WAYNE COUNTY NURSING HOME
Entity type:Organization
Organization Name:WAYNE COUNTY NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LIC ADMINISTRATOR ST
Authorized Official - Phone:931-722-3641
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-0510
Mailing Address - Country:US
Mailing Address - Phone:931-722-3641
Mailing Address - Fax:931-722-7215
Practice Address - Street 1:104 JV MANGUBAT DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2439
Practice Address - Country:US
Practice Address - Phone:931-722-3641
Practice Address - Fax:931-722-7215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000278313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440200Medicaid
TN7440200Medicaid