Provider Demographics
NPI:1275536047
Name:LAWRENCEBURG NH OPERATIONS, LLC
Entity Type:Organization
Organization Name:LAWRENCEBURG NH OPERATIONS, LLC
Other - Org Name:COUNTRYSIDE HEALTHCARE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-762-7518
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0986
Mailing Address - Country:US
Mailing Address - Phone:931-762-7518
Mailing Address - Fax:931-762-7823
Practice Address - Street 1:3051 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-6189
Practice Address - Country:US
Practice Address - Phone:931-762-7518
Practice Address - Fax:931-762-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000155314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445280Medicaid
TN7440482Medicaid
TN445280Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TN7440482Medicaid
TN0445280Medicaid