MEDICARE: PRESBYTERIAN HOMES OF TENNESSEE, INC.

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	314000000X	Skilled Nursing Facility	404	TN

General Provider Information

NPI Number	:	1295191401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN HOMES OF TENNESSEE, INC.

Provider Business Mailing Address
First Line	:	801 VANOSDALE RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2497
Country	:	US
Telephone Number	:	865-690-3411
Fax Number	:	865-246-1799

Provider Business Practice Location Address
First Line	:	801 VANOSDALE RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2497
Country	:	US
Telephone Number	:	865-690-3411
Fax Number	:	865-246-1799

Authorized Official
Title or Position	:	VP - ADMINISTRATOR
Name	:	MR. TODD KNIGHT TAYLOR
Credential	:
Telephone Number	:	865-690-3411

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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