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Contact Information

BLACK WOLF HEALTHCARE LLC
524 W MAIN ST
DECATURVILLE, TN38329-8101
 Phone: 731-852-3591
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Facility/Intermediate Care Facility

313M00000X A3[10] Other Nursing Facility
Indicates primary specialty

NPI Profile & details for BLACK WOLF HEALTHCARE LLC

NPI # 1447085782
LBN Legal business name BLACK WOLF HEALTHCARE LLC
Authorized official SOON BURNAM - (TREASURER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/05/2024
Last updated 11/14/2025 - About 7 months ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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