Healthcare Provider Details

I. General information

NPI: 1134129075
Provider Name (Legal Business Name): WELLMONT WEXFORD HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 N JOHN B DENNIS HWY
KINGSPORT TN
37660-4773
US

IV. Provider business mailing address

311 PRINCETON RD STE 1
JOHNSON CITY TN
37601-2026
US

V. Phone/Fax

Practice location:
  • Phone: 423-288-3988
  • Fax: 423-288-3273
Mailing address:
  • Phone: 423-288-3988
  • Fax: 423-288-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number265
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number265
License Number StateTN

VIII. Authorized Official

Name: SHANE EDWIN HILTON
Title or Position: EVP/CFO
Credential:
Phone: 423-302-3467