Southern Manor Living Centers of Lebanon, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ACL0000000158 Issued in TN

Legal business name

SOUTHERN MANOR LIVING CENTERS OF LEBANON, LLC

Practice address

900 Coles Ferry Pike
Lebanon, TN 37087-5677

Phone

(615) 443-7929

Fax

(615) 443-7502

NPI assigned

Jan 11, 2013

Last updated

Jan 11, 2013By 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

Mrs. Jennifer A Bradshaw, LPN

Title

Executive Director

Phone

(615) 443-7929

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357862400000",
    "number": "1891032710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 COLES FERRY PIKE",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370875677",
            "telephone_number": "615-443-7929",
            "fax_number": "615-443-7502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 COLES FERRY PIKE",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370875677",
            "telephone_number": "615-443-7929",
            "fax_number": "615-443-7502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MANOR LIVING CENTERS OF LEBANON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-11",
        "last_updated": "2013-01-11",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "615-443-7929",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TN",
            "license": "ACL0000000158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Lebanon, TN
• Providers in Lebanon, 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 Jan 11, 2013; 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.