Provider Demographics
NPI:1932291887
Name:HERMITAGE MEDICAL INVESTORS, INC.
Entity Type:Organization
Organization Name:HERMITAGE MEDICAL INVESTORS, INC.
Other - Org Name:HERMITAGE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-543-2571
Mailing Address - Street 1:1633 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-4115
Mailing Address - Country:US
Mailing Address - Phone:423-543-2571
Mailing Address - Fax:423-543-8533
Practice Address - Street 1:1633 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-4115
Practice Address - Country:US
Practice Address - Phone:423-543-2571
Practice Address - Fax:423-543-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000314314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN77546907OtherTPIN
TN7440541Medicaid
TN4090129OtherBLUE CROSS BLUE SHIELD
TN77546907OtherTPIN