Healthcare Provider Details

I. General information

NPI: 1871605287
Provider Name (Legal Business Name): HANCOCK MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 MAIN ST
SNEEDVILLE TN
37869-3654
US

IV. Provider business mailing address

1423 MAIN ST
SNEEDVILLE TN
37869-3654
US

V. Phone/Fax

Practice location:
  • Phone: 423-733-4783
  • Fax: 423-733-2944
Mailing address:
  • Phone: 423-733-4783
  • Fax: 423-733-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000115
License Number StateTN

VIII. Authorized Official

Name: MR. JOHN SHEEHAN
Title or Position: OWNER
Credential:
Phone: 423-618-1488