Healthcare Provider Details

I. General information

NPI: 1700295391
Provider Name (Legal Business Name): KNOXVILLE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 LYONS VIEW PIKE
KNOXVILLE TN
37919-6474
US

IV. Provider business mailing address

485 CENTRAL AVE NE
CLEVELAND TN
37311-5541
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-3902
  • Fax:
Mailing address:
  • Phone: 423-478-5953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000141
License Number StateTN

VIII. Authorized Official

Name: MR. KENNETH C HART JR.
Title or Position: TREASURER
Credential:
Phone: 423-584-6755