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Organization
PRESBYTERIAN HOMES OF TENNESSEE, INC.
Active
Organization
PRESBYTERIAN HOMES OF TENNESSEE, INC.
Active
Other names
Shannondale Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
TODD K TAYLOR (VP - ADMINISTRATOR)
(865) 690-3411
Entity
Organization
Contact information
Practice address
801 VANOSDALE RD, KNOXVILLE, TN 37909-2497
(865) 690-3411
(865) 691-3099
Mailing address
801 VANOSDALE RD, KNOXVILLE, TN 37909-2497
(865) 690-3411
(865) 691-3099
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000150
TN
3336L0003X
Long Term Care Pharmacy
1295
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445105
—
TN
01
—
4407967
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
7440166
—
TN
Enumeration date
06/30/2005
Last updated
07/13/2015
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