Provider Demographics
NPI:1548582125
Name:THOMAS J MABRY & ASSOCIATES
Entity Type:Organization
Organization Name:THOMAS J MABRY & ASSOCIATES
Other - Org Name:MABRY ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-268-0291
Mailing Address - Street 1:100 JETTIE MABRY LN
Mailing Address - Street 2:P.O. BOX 7
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-6078
Mailing Address - Country:US
Mailing Address - Phone:931-268-0291
Mailing Address - Fax:931-268-9241
Practice Address - Street 1:100 JETTIE MABRY LANE
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562
Practice Address - Country:US
Practice Address - Phone:931-268-0291
Practice Address - Fax:931-268-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN254310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility