Provider Demographics
NPI:1689873705
Name:SODDY DAISY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SODDY DAISY HEALTHCARE, LLC
Other - Org Name:SODDY-DAISY HEALTH CARE 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 1:701 SEQUOYAH RD
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-4051
Mailing Address - Country:US
Mailing Address - Phone:423-332-0060
Mailing Address - Fax:423-332-0328
Practice Address - Street 1:701 SEQUOYAH RD
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4051
Practice Address - Country:US
Practice Address - Phone:423-332-0060
Practice Address - Fax:423-332-0328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440590Medicaid
TN0445408Medicaid
TN445408Medicare Oscar/Certification