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	3336L0003X	Long Term Care Pharmacy	1295	TN
2	314000000X	Skilled Nursing Facility	0000000150	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4407967	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316944887
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	:	865-691-3099

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	:	865-691-3099

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/13/2015

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