Provider Demographics
NPI:1477011468
Name:ELK RIVER HEALTH & NURSING CENTER OF FAYETTEVILLE LLC
Entity Type:Organization
Organization Name:ELK RIVER HEALTH & NURSING CENTER OF FAYETTEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-618-1488
Mailing Address - Street 1:3915 ADKISSON DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2821
Mailing Address - Country:US
Mailing Address - Phone:423-834-3188
Mailing Address - Fax:
Practice Address - Street 1:4081 THORNTON TAYLOR PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2674
Practice Address - Country:US
Practice Address - Phone:931-433-9973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility