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General NPI Number Information
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NPI Number | 1164070454
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Entity Type | Organization
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Legal Business Name | HERITAGE AT S PETERS INC
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 273 S PETERS RD
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City | KNOXVILLE
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State | TN
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Zip | 37923-5204
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Country | US
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Telephone | 865-531-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 DALTON PIKE SE
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City | CLEVELAND
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State | TN
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Zip | 37323-9305
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Country | US
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Telephone | 865-888-0307
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARRY HALL
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Credential |
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Telephone | 865-888-0307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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