HOLSTON MANOR
NPI 1356504393
Skilled Nursing Facility in Kingsport, TN

Active since July 09, 2008CLIA 44D0311171 · Waiver
3641 MEMORIAL BLVD, KINGSPORT, TN 37664(423) 246-2411(423) 246-8997 Get Directions Write a Review

NPPES record last updated: May 13, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Holston Manor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HOLSTON MANOR (NPI 1356504393) is a healthcare organization registered as a skilled nursing facility in Kingsport, Tennessee and active in the NPI registry since July 2008. The organization holds a CLIA Waiver certificate valid through December 15, 2026 and lists Rhonda B Nelson, Controller, as its authorized official.

NPPES Registry Identity

NPI1356504393
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameHOLSTON NH OPERATIONS LLC
Location Address3641 MEMORIAL BLVDKingsport, TN 37664-3422
Mailing Address3641 Memorial BlvdKingsport, TN 37664-3422 · (423) 246-2411 · Fax (423) 246-8997
Fax(423) 246-8997
Organization SubpartNo
Authorized OfficialRhonda B NelsonController · (864) 578-6599
Enumeration DateJuly 9, 2008
Last NPPES UpdateMay 13, 2015
NPI 1356504393 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in TN · 0000000264
Definition

(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

3641 MEMORIAL BLVD, Kingsport, TN 37664

Other Names 1

Doing Business AsHolston Manor

Other Identifiers 4

Medicaid0445295TN
Medicaid7440436TN
Medicare NSC6191590001TN
Medicare OSCAR/certification445295TN

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
44D0311171
Facility Type
Skilled Nursing Facility/Nursing Facility
Certificate Effective Date
December 16, 2024
Certificate Expiration Date
December 15, 2026
Laboratory Director
ANGELA SUMNER
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Holston Manor to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for HOLSTON MANOR

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Other Providers at the Same Location


The following 4 providers are registered at the same or a nearby location.

Skilled Nursing Facility
3641 MEMORIAL BLVD
KINGSPORT, TN 37664
Nursing Facility/Intermediate Care Facility
3641 MEMORIAL BLVD
KINGSPORT, TN 37664
Occupational Therapist
3641 MEMORIAL BLVD
KINGSPORT, TN 37664
Skilled Nursing Facility
3641 MEMORIAL BLVD
KINGSPORT, TN 37664

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1356504393, enumerated as an "organization" on July 09, 2008.

The provider is located at 3641 MEMORIAL BLVD KINGSPORT, TN 37664 and the phone number is (423) 246-2411.

Skilled Nursing Facility with taxonomy code 314000000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.