Shady Lawn, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

182 Issued in MS

Legal business name

SHADY LAWN, LLC

Doing business as

Shady Lawn Health and Rehabilitation

Practice address

60 Shady Lawn PL
Vicksburg, MS 39180

Phone

(601) 636-1448

Fax

(601) 636-8811

NPI assigned

Oct 20, 2005

Organization subpart

Yes

Parent organization

VANGUARD HEALTHCARE, LLCAs reported in NPPES

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

Authorized official

Name

Mr. William D. Orand

Title

Ceo

Phone

(615) 250-7100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shady Lawn Health and Rehabilitation Doing business as

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527120000000",
    "number": "1184613143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9020 OVERLOOK BLVD STE 202",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272755",
            "telephone_number": "615-250-7100",
            "fax_number": "615-250-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 SHADY LAWN PL",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "39180",
            "telephone_number": "601-636-1448",
            "fax_number": "601-636-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY LAWN, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VANGUARD HEALTHCARE, LLC",
        "enumeration_date": "2005-10-20",
        "last_updated": "2018-05-24",
        "status": "A",
        "authorized_official_last_name": "ORAND",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-250-7100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00220335",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shady Lawn Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shady Lawn Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; 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.