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Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Unicoi County Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY LYNN KRUTAK (EVP/CFO)
(423) 302-3423
Entity
Organization
Contact information
Practice address
100 GREENWAY CIR, ERWIN, TN 37650-2177
(423) 743-3141
(423) 743-1244
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 743-3141
(423) 743-1244
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
NULL
314000000X
Skilled Nursing Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0445077
MEDICAID SNF
TN
01
—
7440197
MEDICAID ICF
TN
Enumeration date
11/05/2013
Last updated
03/28/2018
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