Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
James H. & Cecile C. Quillen Rehabilitation Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN KRUTAK (SVP/CFO)
(423) 302-3374
Entity
Organization
Contact information
Practice address
2511 WESLEY ST, JOHNSON CITY, TN 37601-1723
(423) 952-1700
(423) 431-6525
Mailing address
311 PRINCETON RD, JOHNSON CITY, TN 37601-2026
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
0000000121
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000262138X
—
GA
05
—
004400631
—
VA
05
—
01620418
—
KY
05
—
01675483
—
NY
05
—
05431336
—
MS
05
—
0579913
—
OH
05
—
091618800
—
FL
05
—
440063
—
NC
05
—
463496
—
SC
05
—
4688190
—
MI
05
—
9802156000
—
WV
05
—
JOH0063N
—
AL
Enumeration date
08/28/2006
Last updated
10/30/2015
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