Provider Demographics
NPI:1316983810
Name:NHC HEALTHCARE-LEWISBURG LLC
Entity type:Organization
Organization Name:NHC HEALTHCARE-LEWISBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:DERYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-424-1456
Mailing Address - Street 1:1653 MOORESVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2005
Mailing Address - Country:US
Mailing Address - Phone:931-359-4506
Mailing Address - Fax:
Practice Address - Street 1:1653 MOORESVILLE HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2005
Practice Address - Country:US
Practice Address - Phone:931-359-4506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
TN177314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445094Medicaid
TN1000607OtherBCBS
702013819OtherCARITEN
7100060OtherUNITED HEALTHCARE
TN7440136Medicaid
0814555OtherHEALTHSPRINGS
702013819OtherCARITEN