MEDICARE: HOLSTON NH OPERATIONS 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	314000000X	Skilled Nursing Facility	0000000264	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356504393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLSTON NH OPERATIONS LLC

Provider Business Mailing 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

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	:	CONTROLLER
Name	:	RHONDA B NELSON
Credential	:
Telephone Number	:	864-578-6599

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	05/13/2015

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Directions to “HOLSTON NH OPERATIONS LLC ” Practice Location

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