Provider Demographics
NPI:1699815399
Name:CLAY COUNTY MANOR
Entity Type:Organization
Organization Name:CLAY COUNTY MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-243-3139
Mailing Address - Street 1:120 PITCOCK LN
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-4058
Mailing Address - Country:US
Mailing Address - Phone:931-243-3139
Mailing Address - Fax:931-243-3169
Practice Address - Street 1:120 PITCOCK LN
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-4058
Practice Address - Country:US
Practice Address - Phone:931-243-3139
Practice Address - Fax:931-243-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000036314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445445Medicaid
TN7440454Medicaid
TN7440454Medicaid