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General NPI Number Information
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NPI Number | 1386634913
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Entity Type | Organization
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Legal Business Name | TENNESSEE BAPTIST ADULT HOMES, INC.
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 700 WILLIAMS FERRY RD
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City | LENOIR CITY
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State | TN
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Zip | 37771-7375
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Country | US
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Telephone | 865-986-3583
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Fax | 865-986-1707
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Provider Business Mailing Address
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Address Line | 700 WILLIAMS FERRY RD
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City | LENOIR CITY
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State | TN
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Zip | 37771-7375
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Country | US
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Telephone | 865-986-3583
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Fax | 865-986-1707
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ANITA L WILMOTH
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Credential | NHA
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Telephone | 865-986-3583
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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 | 31
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 160
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License Number State | TN
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