Provider Demographics
NPI:1467477323
Name:NHC HEALTHCARE-SPARTA LLC
Entity Type:Organization
Organization Name:NHC HEALTHCARE-SPARTA LLC
Other - Org Name:NHC HEALTHCARE, SPARTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-893-2602
Mailing Address - Street 1:34 GRACEY ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-2046
Mailing Address - Country:US
Mailing Address - Phone:931-836-2211
Mailing Address - Fax:
Practice Address - Street 1:34 GRACEY ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2046
Practice Address - Country:US
Practice Address - Phone:931-836-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN284314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440286Medicaid
TN1000684OtherBCBS
TN0445130Medicaid
TN7440286Medicaid