Management Care Corporation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000340 Issued in TN

Legal business name

MANAGEMENT CARE CORPORATION

Practice address

115 Woodlawn Dr
Johnson City, TN 37604-5978

Phone

(423) 975-0095

Fax

(423) 928-0358

NPI assigned

Dec 15, 2005

Organization subpart

No

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

Authorized official

Name

Jimmy R Lewis

Title

President

Phone

(423) 975-5455

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lakebridge Health Care Center Doing business as

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245216910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 WOODLAWN DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045978",
            "telephone_number": "423-975-0095",
            "fax_number": "423-928-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 WOODLAWN DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045978",
            "telephone_number": "423-975-0095",
            "fax_number": "423-928-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANAGEMENT CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-975-5455"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440576",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445358",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakebridge Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sulleman Malik, MD
• Anjali Malkani, M.D.
• Sameer Ahmed Mallick, MBBS
• Hailey Malone, LPN
• Haley Edwards Malone, APRN
• Nora Nery Manalo, MD
• Nicole M Mancini, DDS
• Stephanie C Manginelli, M.D.
• Laura Kathryn Mann, DO
• Elizabeth Ann Mannino, MD

• Skilled Nursing Facility in Johnson City, TN
• Providers in Johnson City, 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 Aug 22, 2020; 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.