Healthcare Provider Details

I. General information

NPI: 1013838937
Provider Name (Legal Business Name): ETOWAH OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 GRADY RD
ETOWAH TN
37331-1903
US

IV. Provider business mailing address

409 GRADY RD
ETOWAH TN
37331-1903
US

V. Phone/Fax

Practice location:
  • Phone: 423-263-1138
  • Fax: 423-263-8876
Mailing address:
  • Phone: 423-263-1138
  • Fax: 423-263-8876

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: JOSHUA STURM
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 646-934-3697