Basic Information
| Provider Information | |||||||||
| NPI: | 1588747984 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLEDSOE COUNTY NURSING HOME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 WHEELERTOWN AVE | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373675246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234476811 | ||||||||
| FaxNumber: | 4234476971 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 WHEELERTOWN AVE | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234476811 | ||||||||
| FaxNumber: | 4234476971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BOYNTON | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4234472112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | TN | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.