MEDICARE: GERIATRICARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	APN6094	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194973073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRICARE, LLC

Provider Business Mailing Address
First Line	:	636 DORA ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37665-1016
Country	:	US
Telephone Number	:	423-677-2222
Fax Number	:	423-246-1026

Provider Business Practice Location Address
First Line	:	3641 MEMORIAL BLVD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3422
Country	:	US
Telephone Number	:	423-246-2411
Fax Number	:	423-246-8997

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LINDA S QUILLEN
Credential	:	GNP
Telephone Number	:	423-677-2222

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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Directions to “GERIATRICARE, LLC ” Practice Location

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