Healthcare Provider Details

I. General information

NPI: 1649252560
Provider Name (Legal Business Name): HUNTSVILLE NH OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 BAKER ST
HUNTSVILLE TN
37756-3444
US

IV. Provider business mailing address

287 BAKER ST
HUNTSVILLE TN
37756-3444
US

V. Phone/Fax

Practice location:
  • Phone: 423-663-3600
  • Fax:
Mailing address:
  • Phone: 423-663-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number223
License Number StateTN

VIII. Authorized Official

Name: CARLA D BUTTRAM
Title or Position: ADMINISTRATOR
Credential: BSM LNHA
Phone: 423-663-3600