Provider Demographics
NPI:1316179575
Name:CHRISTIAN CARE CENTER OF BEDFORD COUNTY, LLC
Entity Type:Organization
Organization Name:CHRISTIAN CARE CENTER OF BEDFORD COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RISK CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAWOOD-GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-416-9595
Mailing Address - Street 1:835 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2607
Mailing Address - Country:US
Mailing Address - Phone:931-680-2300
Mailing Address - Fax:931-680-2273
Practice Address - Street 1:835 UNION ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2607
Practice Address - Country:US
Practice Address - Phone:931-680-2300
Practice Address - Fax:931-680-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000006313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445171Medicaid
TN7440008Medicaid
TN0445171Medicaid
TN7440008Medicaid