Active NPI
Jellico Community Hospital, Inc
Doing business as Care Plus Rehab
- Rehabilitation Hospital Unit
- Williamsburg, KY
National Provider Identifier
1891952248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Hospital Unit
- Legal business name
- JELLICO COMMUNITY HOSPITAL, INC
- Doing business as
- Care Plus Rehab
- Practice address
- 998 S Highway 25 W
Williamsburg, KY 40769-1692 - Phone
- (606) 549-1183
- Fax
- (606) 549-8107
- NPI assigned
- May 21, 2008
- Reactivated
- May 22, 2012
- Last updated
- Mar 10, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Evelyn Ghulam
- Title
- Controller
- Phone
- (423) 784-1334
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Hospital Unit | 273Y00000X | Primary |
Addresses
Primary practice location
998 S Highway 25 W
Williamsburg, KY 40769-1692
Mailing address
188 Hospital LN
Jellico, TN 37762-4400
Phone (423) 784-1272
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01620848 | Medicaid | KY | |
| 0440180 | Medicaid | TN |
Other names 1
- Care Plus Rehab
National Provider Directory
National Provider Directory- Tax ID family
- Care Plus Rehab
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba CarePlus Oneida
- Rural Health Clinic/Center
- Oneida, TN
- NPI 1699296673
-
- Skilled Nursing Facility
- Jellico, TN
- NPI 1548580046
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211328000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1457568000000",
"number": "1891952248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "188 HOSPITAL LN",
"city": "JELLICO",
"state": "TN",
"postal_code": "377624400",
"telephone_number": "423-784-1272",
"fax_number": "723-784-1136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "998 S HIGHWAY 25 W",
"city": "WILLIAMSBURG",
"state": "KY",
"postal_code": "407691692",
"telephone_number": "606-549-1183",
"fax_number": "606-549-8107"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JELLICO COMMUNITY HOSPITAL, INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-05-21",
"last_updated": "2016-03-10",
"deactivation_date": "2011-12-06",
"reactivation_date": "2012-05-22",
"status": "A",
"authorized_official_last_name": "GHULAM",
"authorized_official_first_name": "EVELYN",
"authorized_official_title_or_position": "CONTROLLER",
"authorized_official_telephone_number": "423-784-1334"
},
"taxonomies": [
{
"code": "273Y00000X",
"taxonomy_group": "",
"desc": "Rehabilitation Unit",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01620848",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0440180",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Care Plus Rehab",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Williamsburg, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.