Organization
SOUTHERN MANOR LIVING CENTERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL PENDERGRASS MSN (EXECUTIVE DIRECTOR)
(931) 433-5000
Entity
Organization
Contact information
Practice address
115 MEDICAL CENTER BLVD, FAYETTEVILLE, TN 37334-2689
(931) 433-5000
(931) 433-6908
Mailing address
115 MEDICAL CENTER BLVD, FAYETTEVILLE, TN 37334-2689
(931) 433-5000
(931) 433-6908
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ACL0000000215
TN
Other
Enumeration date
02/28/2011
Last updated
02/28/2011
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