Organization
SANDGALA, LLC
Active
Other names
Crown Cypress
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY BELLANDE (MGMT COMPANY REPRESENTATIVE)
(502) 228-8131
Entity
Organization
Contact information
Practice address
2424 E STONE DR, KINGSPORT, TN 37660-4739
(423) 378-3100
(423) 378-5632
Mailing address
2424 E STONE DR, KINGSPORT, TN 37660-4739
(423) 378-3100
(423) 378-5632
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
L000000012140
TN
310400000X
Assisted Living Facility
Primary
0000000038
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H445537
TENNCARE/MEDICAID
TN
Enumeration date
11/18/2013
Last updated
11/18/2013
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