1003954793 NPI number — JAMESTOWNE ASSISTED LIVING

Table of content: (NPI 1003954793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003954793 NPI number — JAMESTOWNE ASSISTED LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMESTOWNE ASSISTED LIVING
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:
JAMESTOWNE, AN ASSISTED LIVING COMMUNITY
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:
1003954793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
851 LAWNVILLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37763-4666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-376-3030
Provider Business Mailing Address Fax Number:
865-376-3035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
851 LAWNVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37763-4666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-376-3030
Provider Business Practice Location Address Fax Number:
865-376-3035
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRENTHAM
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
865-293-6563

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  ACL0000000037 , 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)





Copyright © 2007-2024 www.npivalidator.com