Organization
MITCHELL MANOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN THOMAS (ADMINISTRATOR)
(615) 444-2882
Entity
Organization
Contact information
Practice address
152 S COLLEGE ST, LEBANON, TN 37087-3643
(615) 444-2882
(615) 449-9565
Mailing address
152 S COLLEGE ST, LEBANON, TN 37087-3643
(615) 444-2882
(615) 449-9565
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0000000300
TN
314000000X
Skilled Nursing Facility
0000000300
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445332
—
TN
01
—
3016165
BLUE CROSS BLUESHIELD ID
TN
05
—
7440431
—
TN
Enumeration date
03/09/2007
Last updated
09/11/2025
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