Organization
CROCKETT COUNTY NURSING HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARBARA PARK (ADMINISTRATOR)
(731) 696-4541
Entity
Organization
Contact information
Practice address
580 WEST MAIN STREET, ALAMO, TN 38001-0367
(731) 696-4541
(731) 696-4948
Mailing address
PO BOX 367, ALAMO, TN 38001-0367
(731) 696-4541
(731) 696-4948
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0000000029
TN
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0445467
MEDICAID LEVEL II
TN
05
—
7440325
—
TN
Enumeration date
01/16/2007
Last updated
06/23/2020
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