Provider Demographics
NPI:1295191401
Name:PRESBYTERIAN HOMES OF TENNESSEE, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN HOMES OF TENNESSEE, INC.
Other - Org Name:WELLPARK AT SHANNONDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP - ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-690-3411
Mailing Address - Street 1:801 VANOSDALE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2497
Mailing Address - Country:US
Mailing Address - Phone:865-690-3411
Mailing Address - Fax:865-246-1799
Practice Address - Street 1:801 VANOSDALE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2497
Practice Address - Country:US
Practice Address - Phone:865-690-3411
Practice Address - Fax:865-246-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN404314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility