Country Place Health Care Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000285 Issued in TN

Legal business name

COUNTRY PLACE HEALTH CARE CENTER

Practice address

80 Justice Street
Crossville, TN 38555

Phone

(931) 484-4782

Fax

(931) 456-0309

NPI assigned

Aug 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cynthia A Wilson

Title

Administrator

Phone

(931) 484-4782

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073523692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 687",
            "address_2": "80 JUSTICE STREET",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "38557",
            "telephone_number": "931-484-4782",
            "fax_number": "931-456-0309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 JUSTICE STREET",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "38555",
            "telephone_number": "931-484-4782",
            "fax_number": "931-456-0309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY PLACE HEALTH CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "931-484-4782"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440421",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445167",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "50919",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Carissa Beth Cooper, FNP
• Laura Marie Core, PNP
• Kevin Melanio Corvacho, DDS
• Leigh Cowan, M.A., CCC-A
• Susan S Cower, RN
• Ronnie R. Cox, LPC-MHSP
• Tiffany Renee Cox, B.S.
• Heather Dawn Crabtree, LPN

• Skilled Nursing Facility in Crossville, TN
• Providers in Crossville, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.