Southern Manor Living Centers, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ACL0000000215 Issued in TN

Legal business name

SOUTHERN MANOR LIVING CENTERS, LLC

Practice address

115 Medical Center Blvd
Fayetteville, TN 37334-2689

Phone

(931) 433-5000

Fax

(931) 433-6908

NPI assigned

Feb 28, 2011

Last updated

Feb 28, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cheryl Pendergrass, MSN

Title

Executive Director

Phone

(931) 433-5000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298851200000",
    "number": "1619274644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 MEDICAL CENTER BLVD",
            "city": "FAYETTEVILLE",
            "state": "TN",
            "postal_code": "373342689",
            "telephone_number": "931-433-5000",
            "fax_number": "931-433-6908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 MEDICAL CENTER BLVD",
            "city": "FAYETTEVILLE",
            "state": "TN",
            "postal_code": "373342689",
            "telephone_number": "931-433-5000",
            "fax_number": "931-433-6908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MANOR LIVING CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2011-02-28",
        "status": "A",
        "authorized_official_last_name": "PENDERGRASS",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "931-433-5000",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TN",
            "license": "ACL0000000215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Smith
• Thomas Smith
• Louisa Morgan Smotherman, LPN
• South Central Human Resource Agency
• Southern Family Medicine LLC
• William K Spears, MD
• Spectrum Therapeutic Learning Center, LLC
• Morgan Honey Spray, LBA, BCBA
• Heather Kilpatrick Stafford, APRN
• Sara Lane Stanly, FNP

• Assisted Living Facility in Fayetteville, TN
• Providers in Fayetteville, TN by specialty
• Assisted Living Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; 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.