Provider Demographics
NPI:1427032648
Name:ROAN HIGHLANDS MEDICAL INVESTORS LLC
Entity type:Organization
Organization Name:ROAN HIGHLANDS MEDICAL INVESTORS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-975-5455
Mailing Address - Street 1:146 BUCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687
Mailing Address - Country:US
Mailing Address - Phone:423-772-0161
Mailing Address - Fax:423-772-3481
Practice Address - Street 1:146 BUCK CREEK RD
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687
Practice Address - Country:US
Practice Address - Phone:423-772-0161
Practice Address - Fax:423-772-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000361313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440586Medicaid
TN0445396Medicaid
TN0445396Medicaid
445396Medicare Oscar/Certification