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NPI Code Detail

MEDICARE: ELK RIVER HEALTH & NURSING CENTER OF FAYETTEVILLE LLC

MEDICARE: ELK RIVER HEALTH & NURSING CENTER OF FAYETTEVILLE 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1477011468
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELK RIVER HEALTH & NURSING CENTER OF FAYETTEVILLE LLC
Provider Business Mailing Address
First Line : 3915 ADKISSON DR NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-2821
Country : US
Telephone Number : 423-834-3188
Fax Number :
Provider Business Practice Location Address
First Line : 4081 THORNTON TAYLOR PKWY
Second Line :
City : FAYETTEVILLE
State : TN
Zip : 37334-2674
Country : US
Telephone Number : 931-433-9973
Fax Number :
Authorized Official
Title or Position : TRUSTEE
Name : JOHN SHEEHAN
Credential :
Telephone Number : 423-618-1488
Provider Enumeration Date : 03/08/2019
Last Update Date : 06/07/2022

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