SOUTHERN MANOR LIVING CENTERS, LLC (NPI# 1619274644) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619274644 |
| Entity Type | Organization |
| Organization Name | SOUTHERN MANOR LIVING CENTERS, LLC |
| Practice Address |
115 Medical Center Blvd Fayetteville TN 37334-2689 |
| Practice Telephone | 9314335000 |
| Practice Fax Number | 9314336908 |
| Mailing Telephone | 9314335000 |
| Mailing Fax Number | 9314336908 |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2011-02-28 |
| Authorized Official Name | CHERYL PENDERGRASS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9314335000 |
| Authorized Official Credential | MSN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | ACL0000000215 | TN | Nursing & Custodial Care Facilities |
| Street Address |
115 MEDICAL CENTER BLVD |
| City | FAYETTEVILLE |
| State | TN |
| Zip Code | 37334-2689 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772086 | Fayetteville Operator LLC | Assisted Living Facility | 115 Medical Center Blvd, Fayetteville, TN 37334-2689 | 2020-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902385198 | Denisia Bernadette Maldonado | Specialist/Technologist, Other | 108 Medical Center Blvd., Suite #100, Fayetteville, TN 37334 | 2018-08-09 |
| 1457801011 | Joshua Meadows | Specialist/Technologist | 101 Industrial Blvd, Fayetteville, TN 37334 | 2016-10-07 |
| 1891083762 | Kathryn Clare Moran | Physical Therapist | 1412 Huntsville Hwy, Fayetteville, TN 37334 | 2011-07-13 |
| 1891997714 | Calvin H Parks | Chiropractor | 1321 Huntsville Hwy, Fayetteville, TN 37334 | 2007-06-04 |
| 1225249691 | Stacey Starr Pace | Family Medicine | 1931 Wilson Pky, Suite A, Fayetteville, TN 37334 | 2007-05-25 |
| 1144388992 | Tom Spain Bigham IIi | Dentist | 608 West College Street, Fayetteville, TN 37334 | 2006-12-05 |
| 1932286259 | Alan B Drewry | Dentist | 602 West College Street, Fayetteville, TN 37334 | 2006-11-01 |
| 1083724561 | Samuel Michael Ashby | Internal Medicine | 804 William D Jones Blvd, Fayetteville, TN 37334 | 2006-08-30 |
| 1194336818 | Collin Amos | Pharmacist | 1000 Huntsville Hwy, Fayetteville, TN 37334 | 2020-08-14 |
| 1629450614 | William Daniel | Nurse Practitioner | 106 Medical Center Blvd, Fayetteville, TN 37334 | 2015-06-25 |
| Find all providers in zip 37334 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306383450 | Family First Operating, LLC | Assisted Living Facility | 113 Medical Center Blvd, Fayetteville, TN 37334-2685 | 2017-01-27 |
| 1235494246 | Phenix Enterprise Services, LLC | Assisted Living Facility | 180 Championship Ct, Fayetteville, GA 30215-8017 | 2012-07-06 |
| 1871723791 | Carillon Assisted Living of Fayetteville, LLC | Assisted Living Facility | 1164 71st School Rd, Fayetteville, NC 28314-2817 | 2009-07-27 |
| 1750517496 | Miracle Restoration | Assisted Living Facility | 4850 Old Savannah Church Rd, Fayetteville, NC 28312-9183 | 2009-06-09 |
| 1770737504 | Lauren & Londen, Inc. | Assisted Living Facility | 610 Mann St, Fayetteville, NC 28301-6240 | 2008-11-06 |
| 1003079872 | Valley Pines Adult Care | Assisted Living Facility | 2521 Muriel Dr, Fayetteville, NC 28306-3213 | 2008-07-02 |
| 1740466937 | Magnolia Lane LLC | Assisted Living Facility | 3510 Camden Rd, Fayetteville, NC 28306-7717 | 2008-01-17 |
| 1528189917 | Cedar Creek Assisted Living, LLC | Assisted Living Facility | 1124 Cedar Creek Rd, Fayetteville, NC 28312-6544 | 2007-04-03 |
| 1346370459 | Peterkin & Associates, Inc. | Assisted Living Facility | 7559 Decatur Dr, Fayetteville, NC 28303-1989 | 2007-03-07 |
| 1841320330 | Hope Rest Home, Inc. | Assisted Living Facility | 2967 Dunn Rd, Fayetteville, NC 28312-8883 | 2007-03-06 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 37334 |
Please comment or provide details below to improve the information on SOUTHERN MANOR LIVING CENTERS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.