Provider Demographics
NPI:1295726743
Name:JOHN M REED HOME FOR THE AGED, INC
Entity type:Organization
Organization Name:JOHN M REED HOME FOR THE AGED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:NHA/ALA
Authorized Official - Phone:423-257-6122
Mailing Address - Street 1:124 JOHN M REED RD
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-2682
Mailing Address - Country:US
Mailing Address - Phone:423-257-6122
Mailing Address - Fax:423-257-2609
Practice Address - Street 1:124 JOHN M REED RD
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:TN
Practice Address - Zip Code:37681-2682
Practice Address - Country:US
Practice Address - Phone:423-257-6122
Practice Address - Fax:423-257-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000004310400000X
TN0000000293313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440107Medicaid
TN7440107Medicaid