Provider Demographics
NPI:1881723427
Name:CONSULATE MANAGEMENT
Entity type:Organization
Organization Name:CONSULATE MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STONEBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-892-1716
Mailing Address - Street 1:8249 STANDIFER GAP RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-5046
Mailing Address - Country:US
Mailing Address - Phone:423-892-1716
Mailing Address - Fax:423-892-3709
Practice Address - Street 1:8249 STANDIFER GAP RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5046
Practice Address - Country:US
Practice Address - Phone:423-892-1716
Practice Address - Fax:423-892-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000114314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440547Medicaid
TN0445205Medicaid
TN445205AMedicare ID - Type UnspecifiedMEDICARE