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Organization
CHRISTIAN CARE CENTER OF RUTHERFORD COUNTY LLC
Active
Organization
CHRISTIAN CARE CENTER OF RUTHERFORD COUNTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M. CAWOOD-GRAY (RISK CONSULTANT)
(423) 975-5455
Entity
Organization
Contact information
Practice address
202 ENON SPRINGS ROAD EAST, SMYRNA, TN 37167
(615) 459-5600
(615) 459-7022
Mailing address
2020 NORTHPARK, SUITE 2D, JOHNSON CITY, TN 37604-3127
(423) 975-5455
(423) 975-5405
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
0000000221
TN
314000000X
Skilled Nursing Facility
Primary
0000000221
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445502
—
TN
05
—
7440610
—
TN
Enumeration date
06/18/2010
Last updated
02/13/2012
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