Provider Demographics
NPI:1477595775
Name:INTEGRITY HEALTHCARE OF CLARKSVILLE, LLC
Entity Type:Organization
Organization Name:INTEGRITY HEALTHCARE OF CLARKSVILLE, LLC
Other - Org Name:GENERAL CARE CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLARK DANKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:423-308-1845
Mailing Address - Street 1:111 USSERY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4530
Mailing Address - Country:US
Mailing Address - Phone:931-641-0269
Mailing Address - Fax:931-553-8129
Practice Address - Street 1:111 USSERY RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4530
Practice Address - Country:US
Practice Address - Phone:931-647-0269
Practice Address - Fax:931-553-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440365Medicaid
445433Medicare Oscar/Certification