Organization
SOUTHERN MANOR LIVING CENTERS OF LEBANON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER A BRADSHAW LPN (EXECUTIVE DIRECTOR)
(615) 443-7929
Entity
Organization
Contact information
Practice address
900 COLES FERRY PIKE, LEBANON, TN 37087-5677
(615) 443-7929
(615) 443-7502
Mailing address
900 COLES FERRY PIKE, LEBANON, TN 37087-5677
(615) 443-7929
(615) 443-7502
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ACL0000000158
TN
Other
Enumeration date
01/11/2013
Last updated
01/11/2013
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