Healthcare Provider Details

I. General information

NPI: 1588747984
Provider Name (Legal Business Name): BLEDSOE COUNTY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WHEELERTOWN AVE
PIKEVILLE TN
37367
US

IV. Provider business mailing address

107 WHEELERTOWN AVE
PIKEVILLE TN
37367-5246
US

V. Phone/Fax

Practice location:
  • Phone: 423-447-6811
  • Fax: 423-447-6971
Mailing address:
  • Phone: 423-447-6811
  • Fax: 423-447-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateTN

VIII. Authorized Official

Name: MRS. STEPHANIE RENEE BOYNTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 423-447-2112