Provider Demographics
NPI:1285622928
Name:THE KING'S DAUGHTERS AND SONS HOME
Entity type:Organization
Organization Name:THE KING'S DAUGHTERS AND SONS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:RENA'
Authorized Official - Last Name:BLANCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-272-7405
Mailing Address - Street 1:PO BOX 341227
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38184-1227
Mailing Address - Country:US
Mailing Address - Phone:901-272-7405
Mailing Address - Fax:901-272-7422
Practice Address - Street 1:3568 APPLING RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2704
Practice Address - Country:US
Practice Address - Phone:901-272-7405
Practice Address - Fax:901-272-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN244314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440194Medicaid
TN0445221Medicaid
TN1285622928Medicare NSC
TN0445221Medicaid