# JEFFERSON COUNTY NURSING HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285624361
- **Authorized official:** ROGER L MYNATT (ADMINISTRATOR)
- **Authorized official phone:** (865) 397-3163

## Contact information

- **Practice address:** 914 INDUSTRIAL PARK RD, DANDRIDGE, TN 37725-4700
- **Practice address phone:** (865) 397-3163
- **Practice address fax:** (865) 397-4225
- **Mailing address:** 914 INDUSTRIAL PARK RD, DANDRIDGE, TN 37725-4700
- **Mailing address phone:** (865) 397-3163
- **Mailing address fax:** (865) 397-4225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 138 | TN | Yes |

## Other

- **Enumeration date:** 10/28/2005
- **Last updated:** 08/29/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7440105 | — | TN |