Provider Demographics
NPI:1972684447
Name:CHRISTIAN HOME FOR THE AGED, INC.
Entity Type:Organization
Organization Name:CHRISTIAN HOME FOR THE AGED, INC.
Other - Org Name:CORNERSTONE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LINTHICUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-610-8507
Mailing Address - Street 1:2012 SHERWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5230
Mailing Address - Country:US
Mailing Address - Phone:423-232-8200
Mailing Address - Fax:423-610-8515
Practice Address - Street 1:2012 SHERWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5230
Practice Address - Country:US
Practice Address - Phone:423-232-8200
Practice Address - Fax:423-610-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0289313M00000X
TN289314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440022Medicaid
TN445483Medicare Oscar/Certification
TN445483Medicare UPIN
TN0538410001Medicare NSC