Organization
HOLSTON MANOR SNF OPERATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MENUCHA GOODMAN (AUTHORIZED OFFICIAL)
(732) 268-1810
Entity
Organization
Contact information
Practice address
3641 MEMORIAL BLVD, KINGSPORT, TN 37664-3422
(423) 246-2411
Mailing address
3641 MEMORIAL BLVD, KINGSPORT, TN 37664-3422
(423) 246-2411
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
10/29/2021
Last updated
02/04/2026
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