| NPI | 1720105851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY RICHARD WEST Executive Director 423-663-3818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X (Licence: TN L 3(20)4M5-066-1387) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: TN PSS0000000124) |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2019-04-01 |