Provider Demographics
NPI:1649252560
Name:HUNTSVILLE NH OPERATIONS, LLC
Entity type:Organization
Organization Name:HUNTSVILLE NH OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUTTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:BSM LNHA
Authorized Official - Phone:423-663-3600
Mailing Address - Street 1:287 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756-3444
Mailing Address - Country:US
Mailing Address - Phone:423-663-3600
Mailing Address - Fax:
Practice Address - Street 1:287 BAKER ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-3444
Practice Address - Country:US
Practice Address - Phone:423-663-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN223314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN744-0485Medicaid
TN0445288Medicaid
TN0445288Medicaid
TN5146540001Medicare NSC