| NPI | 1366450090 |
|---|---|
| Doing Business As | CANON LODGE CARE CENTER |
| Entity Type | Organization |
| Authorized Contact | CINDY S CROSS Assistant Secretary 423-473-5867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: CO 0418) |
| Additional Taxonomies | 385H00000X Respite Care |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-09-15 |