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General NPI Number Information
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NPI Number | 1083752901
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Entity Type | Organization
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Legal Business Name | ST. MARY'S HOLSTON HEALTH AND REHABILITATION CENTER, INC.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 3916 BOYDS BRIDGE PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37914-6233
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Country | US
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Telephone | 865-524-1500
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Fax | 865-524-0408
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Provider Business Mailing Address
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Address Line | 3916 BOYDS BRIDGE PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37914-6233
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Country | US
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Telephone | 865-524-1500
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Fax | 865-524-0408
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Authorized Official
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Title or Position | INTERIM CEO
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Name | MR. ANGEL DAVID JIMENEZ
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Credential |
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Telephone | 865-545-7558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0000000333
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License Number State | TN
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