Provider Demographics
NPI:1992157721
Name:PATRIOT PARK ASSISTED LIVING
Entity type:Organization
Organization Name:PATRIOT PARK ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SORRELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-256-2797
Mailing Address - Street 1:209 GUM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5609
Mailing Address - Country:US
Mailing Address - Phone:865-482-9295
Mailing Address - Fax:865-482-9659
Practice Address - Street 1:209 GUM HOLLOW RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5609
Practice Address - Country:US
Practice Address - Phone:865-482-9295
Practice Address - Fax:865-482-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility