Organization
COUNTRY PLACE HEALTH CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA A WILSON (ADMINISTRATOR)
(931) 484-4782
Entity
Organization
Contact information
Practice address
80 JUSTICE STREET, CROSSVILLE, TN 38555
(931) 484-4782
(931) 456-0309
Mailing address
PO BOX 687, 80 JUSTICE STREET, CROSSVILLE, TN 38557
(931) 484-4782
(931) 456-0309
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000285
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445167
—
TN
01
—
50919
BCBS
TN
05
—
7440421
—
TN
Enumeration date
08/08/2006
Last updated
08/22/2020
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