Provider Demographics
NPI:1700326642
Name:LVK CORPORATION SENIOR CARE HOMES
Entity Type:Organization
Organization Name:LVK CORPORATION SENIOR CARE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CARRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-496-5010
Mailing Address - Street 1:267 FARNER RD
Mailing Address - Street 2:
Mailing Address - City:FARNER
Mailing Address - State:TN
Mailing Address - Zip Code:37333-6414
Mailing Address - Country:US
Mailing Address - Phone:423-496-5010
Mailing Address - Fax:423-496-5010
Practice Address - Street 1:267 FARNER RD
Practice Address - Street 2:
Practice Address - City:FARNER
Practice Address - State:TN
Practice Address - Zip Code:37333-6414
Practice Address - Country:US
Practice Address - Phone:423-496-5010
Practice Address - Fax:423-496-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-25
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10000000208713104A0625X
311Z00000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3104A0625XOtherASSISTED LIVING / MENTAL HEALTH
TNQ031202Medicaid