Victorian Square, LLC
Organization Active NPI Assisted Living Facility (Mental Illness) · Rockwood, TN
NPI 1710180955 · NPPES record last updated Jan 24, 2013
Key facts
- NPI
- 1710180955
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility (Mental Illness) 3104A0625X
- License
- ACL0000000147 (TN)
- Legal business name
- VICTORIAN SQUARE, LLC
- Practice address
- 241 S Chamberlain Ave
Rockwood, TN 37854-6542 - Phone
- (865) 354-1133
- Fax
- (865) 354-6371
- NPI assigned
- Jun 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Ralph H Bellande
- Title
- Managing Partner
- Phone
- (502) 228-8131
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility (Mental Illness) | 3104A0625X | ACL0000000147 | TN | Yes |
Addresses
Primary practice location
241 S Chamberlain Ave
Rockwood, TN 37854-6542
Mailing address
12933 W Highway 42
Prospect, KY 40059-9107
Phone (502) 228-8131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4262690 | Other | TN | TENNCARE/MEDICAID |
Other names
- Victorian Square Assisted Living Facility
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All providers in Rockwood, TN · Assisted Living Facility (Mental Illness) in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.