Kingsport NH Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000261 Issued in TN

Legal business name

KINGSPORT NH OPERATIONS, LLC

Doing business as

Brookhaven Manor

Practice address

2035 Stonebrook Place
Kingsport, TN 37660-4000

Phone

(423) 246-8934

Fax

(423) 246-9280

NPI assigned

Oct 4, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Judy L Johnson

Title

Office Manager

Phone

(423) 246-8934

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Brookhaven Manor Doing business as

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1871580886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2035 STONEBROOK PLACE",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604000",
            "telephone_number": "423-246-8934",
            "fax_number": "423-246-9280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2035 STONEBROOK PLACE",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604000",
            "telephone_number": "423-246-8934",
            "fax_number": "423-246-9280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSPORT NH OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-246-8934",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440460",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445174",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookhaven Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Kingsport, TN
• Providers in Kingsport, 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 20, 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.