CLC of Manchester, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000032 Issued in TN

Legal business name

CLC OF MANCHESTER, LLC

Doing business as

Manchester Community Living Center

Practice address

30 Powers Bridge Rd
Manchester, TN 37355-2806

Phone

(931) 728-7549

Fax

(931) 728-4608

NPI assigned

Oct 25, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Douglas M. Wright Jr.

Title

Managing Member

Phone

(662) 680-3148

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Manchester Community Living Center Doing business as

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1689664369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 POWERS BRIDGE RD",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373552806",
            "telephone_number": "931-728-7549",
            "fax_number": "931-728-4608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 POWERS BRIDGE RD",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373552806",
            "telephone_number": "931-728-7549",
            "fax_number": "931-728-4608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLC OF MANCHESTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-25",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "662-680-3148",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "744-0232",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manchester Community Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Coffee Associates a Medical Management Organization, LLC (Rapha Centre)
• Coffee County Board of Education (Coffee County Schools)
• Coffee County Drug Court
• Coffee County Hospital Group Inc (Medical Center of Manchester)
• Coffee County Hospital Group, Inc

• Skilled Nursing Facility in Manchester, TN
• Providers in Manchester, 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 Feb 28, 2008; 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.