Provider Demographics
NPI:1508057456
Name:LP CLEVELAND LLC
Entity Type:Organization
Organization Name:LP CLEVELAND LLC
Other - Org Name:SIGNATURE HEALTHCARE OF CLEVELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7800
Mailing Address - Fax:502-568-7150
Practice Address - Street 1:2750 EXECUTIVE PARK NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2722
Practice Address - Country:US
Practice Address - Phone:423-476-4444
Practice Address - Fax:423-472-4542
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP CR HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-06
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445369Medicaid
TN7440513Medicaid
TN7440513Medicaid
6105420001Medicare NSC