Provider Demographics
NPI:1952418030
Name:BRAKEBILL NURSING HOME
Entity type:Organization
Organization Name:BRAKEBILL NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-3902
Mailing Address - Street 1:5837 LYONS VIEW PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6474
Mailing Address - Country:US
Mailing Address - Phone:865-584-3902
Mailing Address - Fax:865-584-2122
Practice Address - Street 1:5837 LYONS VIEW PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6474
Practice Address - Country:US
Practice Address - Phone:865-584-3902
Practice Address - Fax:865-584-2122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAKEBILL NURSING HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000662OtherBCBS
TN0445114Medicaid
TN0445114Medicaid