Provider Demographics
NPI:1891131801
Name:NORTHCLIFF, ACLF
Entity Type:Organization
Organization Name:NORTHCLIFF, ACLF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR, STAFF NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:731-549-7290
Mailing Address - Street 1:14691 HIGHWAY 22 N
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-4825
Mailing Address - Country:US
Mailing Address - Phone:731-249-5970
Mailing Address - Fax:
Practice Address - Street 1:14691 HIGHWAY 22 N
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-4825
Practice Address - Country:US
Practice Address - Phone:731-249-5970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000369305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service