Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Unicoi County Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY LYNN KRUTAK (EVP/CFO)
(423) 302-3423
Entity
Organization
Contact information
Practice address
100 GREENWAY CIR, ERWIN, TN 37650-2177
(423) 743-3141
(423) 743-1244
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 743-3141
(423) 743-1244
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0445077
MEDICAID SNF
TN
01
—
7440197
MEDICAID ICF
TN
Enumeration date
11/05/2013
Last updated
03/28/2018
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