Provider Demographics
NPI:1811219397
Name:RICHLAND PLACE SENIOR LIVING
Entity Type:Organization
Organization Name:RICHLAND PLACE SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:LAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-325-4440
Mailing Address - Street 1:201 RICHLAND LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1775
Mailing Address - Country:US
Mailing Address - Phone:615-325-4440
Mailing Address - Fax:615-325-4407
Practice Address - Street 1:201 RICHLAND LAKE DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1775
Practice Address - Country:US
Practice Address - Phone:615-325-4440
Practice Address - Fax:615-325-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000299310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility