Organization
CHRISTIAN CARE CENTER OF BRISTOL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY R. LEWIS (CHIEF MANAGER)
(423) 975-5455
Entity
Organization
Contact information
Practice address
2830 HIGHWAY 394, BLOUNTVILLE, TN 37617-5577
(423) 232-6005
(423) 975-5405
Mailing address
2020 NORTHPARK DR STE 2D, JOHNSON CITY, TN 37604-3127
(423) 975-5455
(423) 975-5405
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
TN0000000260
TN
314000000X
Skilled Nursing Facility
Primary
TN0000000260
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000260
STATE OF TENNESSEE FACILITY LICENSE
TN
Enumeration date
07/24/2017
Last updated
06/16/2018
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