Provider Demographics
NPI:1962486183
Name:SWEETWATER NURSING CENTER INC
Entity Type:Organization
Organization Name:SWEETWATER NURSING CENTER INC
Other - Org Name:SWEETWATER NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-975-5455
Mailing Address - Street 1:978 HIGHWAY 11 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874
Mailing Address - Country:US
Mailing Address - Phone:423-337-6631
Mailing Address - Fax:423-337-3801
Practice Address - Street 1:978 HIGHWAY 11 SOUTH
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874
Practice Address - Country:US
Practice Address - Phone:423-337-6631
Practice Address - Fax:423-337-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000187313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440192Medicaid
TN0445456Medicaid
TN7440192Medicaid
4813050001Medicare NSC