Provider Demographics
NPI:1316944887
Name:PRESBYTERIAN HOMES OF TENNESSEE, INC.
Entity type:Organization
Organization Name:PRESBYTERIAN HOMES OF TENNESSEE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP - ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-690-3411
Mailing Address - Street 1:801 VANOSDALE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2497
Mailing Address - Country:US
Mailing Address - Phone:865-690-3411
Mailing Address - Fax:865-691-3099
Practice Address - Street 1:801 VANOSDALE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2497
Practice Address - Country:US
Practice Address - Phone:865-690-3411
Practice Address - Fax:865-691-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12953336L0003X
TN0000000150314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4407967OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN0445105Medicaid
TN7440166Medicaid