# COFFEE MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** United Regional Medical Center Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063509271
- **Authorized official:** HOLLY B HOPKINS (BUSINESS OFFICE MANAGER)
- **Authorized official phone:** (931) 461-3425

## Contact information

- **Practice address:** 1001 MCARTHUR DRIVE, MANCHESTER, TN 37355
- **Practice address phone:** (931) 728-3586
- **Practice address fax:** (931) 723-0781
- **Mailing address:** 1001 MCARTHUR DRIVE, MANCHESTER, TN 37355
- **Mailing address phone:** (931) 728-3586
- **Mailing address fax:** (931) 723-0781

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 7440354 | TN | — |
| 314000000X | Skilled Nursing Facility | 445383 | TN | Yes |

## Other

- **Enumeration date:** 10/07/2006
- **Last updated:** 06/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0445383 | — | TN |
| 01 | — | 4039933 | BCBS | TN |
| 05 | — | 7440354 | — | TN |