Covenant Living at Shannondale

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

COVENANT LIVING AT SHANNONDALE

Doing business as

Shannondale of Maryville

Practice address

803 Shannondale Way
Maryville, TN 37803-5972

Phone

(865) 982-4599

Fax

(865) 982-3786

NPI assigned

Jul 6, 2005

Last updated

Nov 4, 2024By 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

Elizabeth A Malzahn

Title

SVP Reimbursement

Phone

(773) 878-4430

Specialties & licenses 1

Addresses

Other names 1

• Shannondale of Maryville Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396742334. Details of each certification follow.

• CCN 445472 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 445472

Legal name

PRESBYTERIAN HOMES OF TENNESSEE INC

Doing business as

SHANNONDALE OF MARYVILLE HEALTH CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

Jul 7, 2003

Last certification

Jul 7, 2022

Beds

44

Ownership / control type

Church Related

Multi-facility organization

covenant living

Organization structure

CorporationNon-profit

Incorporated

Apr 6, 1963 in TN

Enrollment address

805 Shannondale Way
Maryville, TN 37803-5972

Nursing home name

SHANNONDALE OF MARYVILLE HEALTH CARE CENTER

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Presbyterian Homes of Tennessee, Inc.

  dba Shannondale Health Care Center

  • Skilled Nursing Facility
  • Knoxville, TN
  • NPI 1316944887

  4789594177

  Same PAC ID

Listed as

Shannondale of Maryville Health Care CenterCCN 445472 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

5 of 5

Type

Medicare

Ownership

Non profit - Church related

Certified

Jul 7, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4439.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Rebecca E Criswell, NP

  • Nurse Practitioner
  • Knoxville, TN
  • NPI 1316314768

  Corporate Director

  CMS ownership
• Stuart Craig Jarvis, MD

  • Gastroenterology Physician
  • Manchester, NH
  • NPI 1467415067

  Corporate Director

  CMS ownership

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Brandon Shane Asbury, M.D.

  • Orthopaedic Surgery Physician
  • Alcoa, TN
  • NPI 1396961785

  Nursing home

  Care Compare affiliation
• David A Knoll, M.D.

  • Internal Medicine Physician
  • Maryville, TN
  • NPI 1306815253

  Nursing home

  Care Compare affiliation
• John Francis Kriese, DO, MSPH

  • Family Medicine Physician
  • Maryville, TN
  • NPI 1366933681

  Nursing home

  Care Compare affiliation
• Madison Witt

  • Family Nurse Practitioner
  • Maryville, TN
  • NPI 1689292948

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1396742334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 VANOSDALE RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092497",
            "telephone_number": "865-690-3411",
            "fax_number": "865-246-1799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 SHANNONDALE WAY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378035972",
            "telephone_number": "865-982-4599",
            "fax_number": "865-982-3786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT LIVING AT SHANNONDALE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-06",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "MALZAHN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SVP REIMBURSEMENT",
        "authorized_official_telephone_number": "773-878-4430"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shannondale of Maryville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victoria Ann Coughlin
• Lisa Coulson, COTA/L
• Amanda Jo Coulter, AGPCNP
• County of Blount
• Stephanie Cousins, RN
• April Shaleen Covington, LMSW
• John D Cowan, M.D.
• David Allan Cox, MD
• James K Cox Jr., M.D.
• Lisa A Cox, AT

• Skilled Nursing Facility in Maryville, TN
• Providers in Maryville, 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 Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.