Bolivar Assisted Care Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ACL00000000182 Issued in TN

Legal business name

BOLIVAR ASSISTED CARE LIVING, LLC

Practice address

631 Nuckolls Rd
Bolivar, TN 38008-1599

Phone

(731) 658-3313

Fax

(731) 658-9889

NPI assigned

May 8, 2009

Last updated

May 8, 2009By 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

Craig Bradford Laman

Title

Member

Phone

(731) 696-4670

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1241740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1982838660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S BELLS ST",
            "address_2": "SUITE #3",
            "city": "ALAMO",
            "state": "TN",
            "postal_code": "380011778",
            "telephone_number": "731-696-4670",
            "fax_number": "731-696-4672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081599",
            "telephone_number": "731-658-3313",
            "fax_number": "731-658-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLIVAR ASSISTED CARE LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-08",
        "last_updated": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "LAMAN",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "BRADFORD",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "731-696-4670"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TN",
            "license": "ACL00000000182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bolivar General Hospital, Inc. (West Tennessee Healthcare Bolivar Hospital)

• Assisted Living Facility in Bolivar, TN
• Providers in Bolivar, 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 May 8, 2009; 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.