Healthcare Provider Details

I. General information

NPI: 1821556812
Provider Name (Legal Business Name): ELK RIVER HEALTH & NURSING CENTER OF ARDMORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 05/03/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24623 UNION HILL ROAD
ARDMORE TN
38449-3155
US

IV. Provider business mailing address

651 E 4TH ST STE 604
CHATTANOOGA TN
37403-1914
US

V. Phone/Fax

Practice location:
  • Phone: 931-427-2143
  • Fax:
Mailing address:
  • Phone: 423-834-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN SHEEHAN
Title or Position: TRUSTEE
Credential:
Phone: 423-618-1488