Provider Demographics
NPI:1679511588
Name:NHC HEALTHCARE-SOMERVILLE LLC
Entity Type:Organization
Organization Name:NHC HEALTHCARE-SOMERVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:DERYL
Authorized Official - Middle Name:DORAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-363-3507
Mailing Address - Street 1:308 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-9716
Mailing Address - Country:US
Mailing Address - Phone:901-465-9861
Mailing Address - Fax:
Practice Address - Street 1:308 LAKE DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-9716
Practice Address - Country:US
Practice Address - Phone:901-465-9861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN078314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000690OtherBCBS TN
TN7440271Medicaid
TN0445119Medicaid
TN1000690OtherBCBS TN