Organization
CENTER ON AGING AND HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER ALEX GADDY (ADMINISTRATOR)
(423) 743-7669
Entity
Organization
Contact information
Practice address
880 S MOHAWK DR, ERWIN, TN 37650-2125
(423) 743-7669
(423) 735-1160
Mailing address
880 S MOHAWK DR, ERWIN, TN 37650-2125
(423) 743-7669
(423) 735-1160
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
378
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445424
—
TN
01
—
4008444
BLUCCROSSBLUESHIELD
TN
05
—
7440598
—
TN
Enumeration date
08/17/2005
Last updated
04/06/2015
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