Provider Demographics
NPI:1386803310
Name:WHITES CREEK HEALTHCARE LLC
Entity type:Organization
Organization Name:WHITES CREEK HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLARK DANKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:423-308-1845
Mailing Address - Street 1:3425 KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WHITES CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37189-9189
Mailing Address - Country:US
Mailing Address - Phone:615-876-2754
Mailing Address - Fax:615-876-9499
Practice Address - Street 1:3425 KNIGHT DR
Practice Address - Street 2:
Practice Address - City:WHITES CREEK
Practice Address - State:TN
Practice Address - Zip Code:37189-9189
Practice Address - Country:US
Practice Address - Phone:615-876-2754
Practice Address - Fax:615-876-9499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445281Medicaid
TN7440544Medicaid
TN7440544Medicaid