Healthcare Provider Details

I. General information

NPI: 1801884010
Provider Name (Legal Business Name): BRADLEY COUNTY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 PEERLESS RD NW
CLEVELAND TN
37312-3742
US

IV. Provider business mailing address

2910 PEERLESS RD NW
CLEVELAND TN
37312-3742
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-7116
  • Fax:
Mailing address:
  • Phone: 423-472-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH H NEWCOMB
Title or Position: ADMINISTRATOR
Credential:
Phone: 423-472-7116