=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013838937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ETOWAH OPCO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2026
-----------------------------------------------------
Last Update Date | 07/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 GRADY RD
-----------------------------------------------------
City | ETOWAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37331-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-263-1138
-----------------------------------------------------
Fax | 423-263-8876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 GRADY RD
-----------------------------------------------------
City | ETOWAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37331-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-263-1138
-----------------------------------------------------
Fax | 423-263-8876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED SIGNATORY
-----------------------------------------------------
Name | JOSHUA STURM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-934-3697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------