Healthcare Provider Details

I. General information

NPI: 1033191390
Provider Name (Legal Business Name): MCMINN MEMORIAL NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 HIGHWAY 411 N
ETOWAH TN
37331-1912
US

IV. Provider business mailing address

886 HIGHWAY 411 N
ETOWAH TN
37331-1912
US

V. Phone/Fax

Practice location:
  • Phone: 423-263-3600
  • Fax: 423-263-3607
Mailing address:
  • Phone: 423-263-3600
  • Fax: 423-263-3607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000165
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0000000165
License Number StateTN

VIII. Authorized Official

Name: MRS. NANCY D MORRIS
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 423-263-3779