Provider Demographics
NPI:1093942385
Name:LEE STREET DEVELOPERS LLC
Entity Type:Organization
Organization Name:LEE STREET DEVELOPERS LLC
Other - Org Name:ROSE OF SHARON'S SENIOR VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:TANEKA
Authorized Official - Last Name:HUDGINS
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:423-822-7673
Mailing Address - Street 1:5410 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37410-2219
Mailing Address - Country:US
Mailing Address - Phone:423-822-7673
Mailing Address - Fax:423-821-2468
Practice Address - Street 1:5410 LEE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37410-2219
Practice Address - Country:US
Practice Address - Phone:423-822-7673
Practice Address - Fax:423-821-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000292310400000X
TNACL000000292385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care