Organization
KINGSPORT NH OPERATIONS, LLC
Active
Other names
Brookhaven Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY L JOHNSON (OFFICE MANAGER)
(423) 246-8934
Entity
Organization
Contact information
Practice address
2035 STONEBROOK PLACE, KINGSPORT, TN 37660-4000
(423) 246-8934
(423) 246-9280
Mailing address
2035 STONEBROOK PLACE, KINGSPORT, TN 37660-4000
(423) 246-8934
(423) 246-9280
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000261
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445174
—
TN
05
—
7440460
—
TN
Enumeration date
10/04/2005
Last updated
11/20/2007
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