# KINGSPORT NH OPERATIONS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Brookhaven Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871580886
- **Authorized official:** MRS. JUDY L JOHNSON (OFFICE MANAGER)
- **Authorized official phone:** (423) 246-8934

## Contact information

- **Practice address:** 2035 STONEBROOK PLACE, KINGSPORT, TN 37660-4000
- **Practice address phone:** (423) 246-8934
- **Practice address fax:** (423) 246-9280
- **Mailing address:** 2035 STONEBROOK PLACE, KINGSPORT, TN 37660-4000
- **Mailing address phone:** (423) 246-8934
- **Mailing address fax:** (423) 246-9280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 0000000261 | TN | Yes |

## Other

- **Enumeration date:** 10/04/2005
- **Last updated:** 11/20/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0445174 | — | TN |
| 05 | — | 7440460 | — | TN |