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General NPI Number Information
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NPI Number | 1134129075
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Entity Type | Organization
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Legal Business Name | WELLMONT WEXFORD HOUSE
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 2421 N JOHN B DENNIS HWY
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City | KINGSPORT
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State | TN
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Zip | 37660-4773
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Country | US
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Telephone | 423-288-3988
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Fax | 423-288-3273
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Provider Business Mailing Address
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Address Line | 311 PRINCETON RD STE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2026
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Country | US
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Telephone | 423-288-3988
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Fax | 423-288-3273
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Authorized Official
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Title or Position | EVP/CFO
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Name | SHANE EDWIN HILTON
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Credential |
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Telephone | 423-302-3467
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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 | 265
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 265
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License Number State | TN
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