Provider Demographics
NPI:1427246123
Name:ADAMSVILLE HEALTHCARE LLC
Entity type:Organization
Organization Name:ADAMSVILLE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FACILITY SUPPORT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-308-1845
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-0325
Mailing Address - Country:US
Mailing Address - Phone:731-632-3301
Mailing Address - Fax:731-632-4111
Practice Address - Street 1:409 PARK AVE
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-2461
Practice Address - Country:US
Practice Address - Phone:731-632-3301
Practice Address - Fax:731-632-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN144314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445397Medicaid
TN7440195Medicaid
TN7440195Medicaid