Provider Demographics
NPI:1891701645
Name:SUMMIT VIEW OF FARRAGUT, LLC
Entity type:Organization
Organization Name:SUMMIT VIEW OF FARRAGUT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, MBA
Authorized Official - Phone:865-675-6444
Mailing Address - Street 1:PO BOX 22280
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37933-0280
Mailing Address - Country:US
Mailing Address - Phone:865-966-0600
Mailing Address - Fax:865-675-6008
Practice Address - Street 1:12823 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-0920
Practice Address - Country:US
Practice Address - Phone:865-966-0600
Practice Address - Fax:865-675-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN113709OtherBCBS#
TN7440449Medicaid
TN044-5258Medicaid
TN113709OtherBCBS#