Basic Information
| Provider Information | |||||||||
| NPI: | 1164467270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNOXVILLE HEALTH CARE CENTER, LP | ||||||||
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| OtherOrganizationName: | NHC HEALTHCARE, FORT SANDERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379161112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655254131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2120 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379161112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655254131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | USSERY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | MICHEAL | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP | ||||||||
| AuthorizedOfficialTelephone: | 6158902020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 319 | TN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0445107 | 05 | TN | MEDICAID | 7440263 | 05 | TN | MEDICAID | 702009000 | 01 | CARITEN SENIOR HEALTH | OTHER | 1000636 | 01 | TN | BCBS | OTHER |