=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720021033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNCREST HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 608 HOSPITAL DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37115-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-865-9841
-----------------------------------------------------
Fax | 615-860-6392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 608 HOSPITAL DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37115-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-865-9841
-----------------------------------------------------
Fax | 615-860-6392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | GARY W RASMUSSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-587-4505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------