Healthcare Provider Details

I. General information

NPI: 1316944887
Provider Name (Legal Business Name): PRESBYTERIAN HOMES OF TENNESSEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VANOSDALE RD
KNOXVILLE TN
37909-2497
US

IV. Provider business mailing address

801 VANOSDALE RD
KNOXVILLE TN
37909-2497
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-3411
  • Fax: 865-691-3099
Mailing address:
  • Phone: 865-690-3411
  • Fax: 865-691-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000150
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1295
License Number StateTN

VIII. Authorized Official

Name: TODD K TAYLOR
Title or Position: VP - ADMINISTRATOR
Credential:
Phone: 865-690-3411