Provider Demographics
NPI:1467774331
Name:ELDER CARE OF KNOXVILLE, LLC
Entity Type:Organization
Organization Name:ELDER CARE OF KNOXVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:APN, GCNS-BC
Authorized Official - Phone:865-386-3148
Mailing Address - Street 1:PO BOX 5649
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37928-0649
Mailing Address - Country:US
Mailing Address - Phone:865-804-5306
Mailing Address - Fax:865-689-1981
Practice Address - Street 1:5112 MALIBU DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-4513
Practice Address - Country:US
Practice Address - Phone:865-804-5306
Practice Address - Fax:865-689-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty