Provider Demographics
NPI:1548708936
Name:SULLIVAN COUNTY REGIONAL HEALTH DEPARTMENT
Entity type:Organization
Organization Name:SULLIVAN COUNTY REGIONAL HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE- PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-279-2777
Mailing Address - Street 1:1041 E SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5242
Mailing Address - Country:US
Mailing Address - Phone:423-279-2777
Mailing Address - Fax:423-224-1640
Practice Address - Street 1:1041 E SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5242
Practice Address - Country:US
Practice Address - Phone:423-279-2777
Practice Address - Fax:423-224-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN206764163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB58933OtherUPIN
3911774OtherMEDICARE
TN=========Medicaid
TN=========Medicare PIN
TN=========Medicare UPIN