Provider Demographics
NPI:1508112673
Name:BLUFF SPRINGS MANOR LLC
Entity Type:Organization
Organization Name:BLUFF SPRINGS MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-668-7899
Mailing Address - Street 1:810 BLUFF SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-7723
Mailing Address - Country:US
Mailing Address - Phone:931-668-7899
Mailing Address - Fax:931-668-7899
Practice Address - Street 1:810 BLUFF SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-7723
Practice Address - Country:US
Practice Address - Phone:931-668-7899
Practice Address - Fax:931-668-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility