Healthcare Provider Details

I. General information

NPI: 1376474833
Provider Name (Legal Business Name): ZUMBRO RIVER HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 HIGHWAY 394
BLOUNTVILLE TN
37617-5577
US

IV. Provider business mailing address

2830 HIGHWAY 394
BLOUNTVILLE TN
37617-5577
US

V. Phone/Fax

Practice location:
  • Phone: 423-274-6191
  • Fax: 423-274-6192
Mailing address:
  • Phone: 423-274-6191
  • Fax: 423-274-6192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WESTON HOLT
Title or Position: LLC MANAGER
Credential:
Phone: 858-798-5700