Organization
JEFFERSON COUNTY NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER L MYNATT (ADMINISTRATOR)
(865) 397-3163
Entity
Organization
Contact information
Practice address
914 INDUSTRIAL PARK RD, DANDRIDGE, TN 37725-4700
(865) 397-3163
(865) 397-4225
Mailing address
914 INDUSTRIAL PARK RD, DANDRIDGE, TN 37725-4700
(865) 397-3163
(865) 397-4225
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
138
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7440105
—
TN
Enumeration date
10/28/2005
Last updated
08/29/2007
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