# COVENANT LIVING AT SHANNONDALE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shannondale of Maryville
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396742334
- **Authorized official:** ELIZABETH A MALZAHN (SVP REIMBURSEMENT)
- **Authorized official phone:** (773) 878-4430

## Contact information

- **Practice address:** 803 SHANNONDALE WAY, MARYVILLE, TN 37803-5972
- **Practice address phone:** (865) 982-4599
- **Practice address fax:** (865) 982-3786
- **Mailing address:** 801 VANOSDALE RD, KNOXVILLE, TN 37909-2497
- **Mailing address phone:** (865) 690-3411
- **Mailing address fax:** (865) 246-1799

## Taxonomy

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

## Other

- **Enumeration date:** 07/06/2005
- **Last updated:** 11/04/2024