Provider Demographics
NPI:1023338753
Name:COLUMBIA SENIOR LIVING, LLC
Entity type:Organization
Organization Name:COLUMBIA SENIOR LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-381-8405
Mailing Address - Street 1:1310 ROSEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-381-8405
Mailing Address - Fax:391-381-8442
Practice Address - Street 1:1310 ROSEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-381-8405
Practice Address - Fax:391-381-8442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODWORKS UNLIMITED, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000077310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445390Medicaid