Healthcare Provider Details

I. General information

NPI: 1841121399
Provider Name (Legal Business Name): ELEVEN POINT RIVER HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WOODLAWN DR
JOHNSON CITY TN
37604-5978
US

IV. Provider business mailing address

115 WOODLAWN DR
JOHNSON CITY TN
37604-5978
US

V. Phone/Fax

Practice location:
  • Phone: 423-975-0095
  • Fax: 423-975-0098
Mailing address:
  • Phone: 423-975-0095
  • Fax: 423-975-0098

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: WESTON HOLT
Title or Position: LLC MANAGER
Credential:
Phone: 858-798-5700