# MOUNTAIN STATES HEALTH ALLIANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Unicoi County Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922437466
- **Authorized official:** MRS. MARY LYNN KRUTAK (EVP/CFO)
- **Authorized official phone:** (423) 302-3423

## Contact information

- **Practice address:** 100 GREENWAY CIR, ERWIN, TN 37650-2177
- **Practice address phone:** (423) 743-3141
- **Practice address fax:** (423) 743-1244
- **Mailing address:** 311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
- **Mailing address phone:** (423) 743-3141
- **Mailing address fax:** (423) 743-1244

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/05/2013
- **Last updated:** 03/28/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0445077 | MEDICAID SNF | TN |
| 01 | — | 7440197 | MEDICAID ICF | TN |