NPIMap

Organization Active NPI

Life Bridges, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Cleveland, TN
National Provider Identifier
1376847251
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
LIFE BRIDGES, INC.
Practice address
209 Kile Lake Road
Cleveland, TN 37323
Phone
(423) 472-5268
Fax
(423) 479-1492
NPI assigned
Jan 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Authorized official

Name
Dr. Lucas Queen
Title
Ceo
Phone
(423) 472-5268

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

209 Kile Lake Road
Cleveland, TN 37323

Mailing address

PO Box 29
Cleveland, TN 37364-0029
Phone (423) 472-5268

Other identifiers 1

IdentifierTypeStateIssuer
3722363MedicaidTN

Other names 1

  • Edgemon House Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 44G140

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LIFE BRIDGES EDGEMON HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 23, 2011
Last certification
Jan 7, 2025
Beds
4
Ownership / control type
Private (non-profit)
Facility address
209 Kile Lake Road
Cleveland, TN 37323

National Provider Directory

National Provider Directory
Tax ID family
Life Bridges Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

209 Kile Lake Rd SE
Cleveland, TN 37323
Phone (423) 472-5268

NPI Registry JSON

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748995200000",
    "number": "1376847251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373640029",
            "telephone_number": "423-472-5268",
            "fax_number": "423-479-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 KILE LAKE ROAD",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "37323",
            "telephone_number": "423-472-5268",
            "fax_number": "423-479-1492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BRIDGES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-06",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A",
        "authorized_official_last_name": "QUEEN",
        "authorized_official_first_name": "LUCAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-472-5268",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3722363",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgemon House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cleveland, TN

Sources for this page

Verify at the official NPI Registry.