Provider Demographics
NPI:1104857622
Name:BRISTOL NURSING HOME, INC.-PHARMACY
Entity Type:Organization
Organization Name:BRISTOL NURSING HOME, INC.-PHARMACY
Other - Org Name:BRISTOL NURSING HOME, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONEYHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-764-6151
Mailing Address - Street 1:261 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1635
Mailing Address - Country:US
Mailing Address - Phone:423-764-6151
Mailing Address - Fax:423-764-6155
Practice Address - Street 1:261 NORTH STREET
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-764-6151
Practice Address - Fax:423-764-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000375313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========Medicare ID - Type UnspecifiedBNH, INC.-PHARMACY