Provider Demographics
NPI:1538467717
Name:HEALTH SERVICES MANCHESTER, LLC
Entity Type:Organization
Organization Name:HEALTH SERVICES MANCHESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:HART
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-584-6755
Mailing Address - Street 1:485 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-5541
Mailing Address - Country:US
Mailing Address - Phone:423-478-5953
Mailing Address - Fax:
Practice Address - Street 1:811 KEYLON STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2419
Practice Address - Country:US
Practice Address - Phone:931-461-3425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000033314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440354Medicaid
TN0445383Medicaid