1689665796 NPI number — PREFERRED HEALTH SERVICES OF TENNESSEE, INC.

Table of content: (NPI 1689665796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689665796 NPI number — PREFERRED HEALTH SERVICES OF TENNESSEE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED HEALTH SERVICES OF TENNESSEE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ONEIDA NURSING & REHAB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689665796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4997
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEIDA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37841-4997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-569-8382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18805 ALBERTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37841-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-569-8382
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
423-308-1845

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  224 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0445254 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7440176 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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