Provider Demographics
NPI:1902997356
Name:CHESTER CO HEALTHCARE, INC.
Entity type:Organization
Organization Name:CHESTER CO HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MAHLIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-989-7598
Mailing Address - Street 1:412 JUANITA DR
Mailing Address - Street 2:P O BOX 223
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1949
Mailing Address - Country:US
Mailing Address - Phone:731-989-7598
Mailing Address - Fax:731-989-7994
Practice Address - Street 1:412 JUANITA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1949
Practice Address - Country:US
Practice Address - Phone:731-989-7598
Practice Address - Fax:731-989-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440034Medicaid
TN7440034Medicaid