Healthcare Provider Details

I. General information

NPI: 1477011468
Provider Name (Legal Business Name): ELK RIVER HEALTH & NURSING CENTER OF FAYETTEVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 THORNTON TAYLOR PKWY
FAYETTEVILLE TN
37334-2674
US

IV. Provider business mailing address

3915 ADKISSON DR NW
CLEVELAND TN
37312-2821
US

V. Phone/Fax

Practice location:
  • Phone: 931-433-9973
  • 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

VIII. Authorized Official

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