Tri-County Convalescent Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000167 Issued in TN

Legal business name

TRI-COUNTY CONVALESCENT HOME

Practice address

409 Park Ave
Adamsville, TN 38310-2461

Phone

(731) 632-3301

Fax

(731) 632-4111

NPI assigned

May 31, 2005

Last updated

Jul 25, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brenda Pickens

Title

Administrator

Phone

(731) 632-3301

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185321600000",
    "number": "1114920469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 PARK AVE",
            "city": "ADAMSVILLE",
            "state": "TN",
            "postal_code": "383102461",
            "telephone_number": "731-632-3301",
            "fax_number": "731-632-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 PARK AVE",
            "city": "ADAMSVILLE",
            "state": "TN",
            "postal_code": "383102461",
            "telephone_number": "731-632-3301",
            "fax_number": "731-632-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY CONVALESCENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2007-07-25",
        "status": "A",
        "authorized_official_last_name": "PICKENS",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "731-632-3301"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445397",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440195",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Adamsville, TN
• Providers in Adamsville, 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 Jul 25, 2007; 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.