Provider Demographics
NPI:1942245816
Name:INTEGRITY HEALTHCARE OF JONESBOROUGH, LLC
Entity Type:Organization
Organization Name:INTEGRITY HEALTHCARE OF JONESBOROUGH, LLC
Other - Org Name:FOUR OAKS 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 1:1101 PERSIMMON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5239
Mailing Address - Country:US
Mailing Address - Phone:423-753-8711
Mailing Address - Fax:
Practice Address - Street 1:1101 PERSIMMON RIDGE RD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-5239
Practice Address - Country:US
Practice Address - Phone:423-753-8711
Practice Address - Fax:423-753-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN292314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440540Medicaid
TN7440540Medicaid