Provider Demographics
NPI:1740070945
Name:MADISON OPERATING GROUP LLC
Entity type:Organization
Organization Name:MADISON OPERATING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANSHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-900-2005
Mailing Address - Street 1:2000 GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3020
Mailing Address - Country:US
Mailing Address - Phone:423-224-6900
Mailing Address - Fax:423-224-3759
Practice Address - Street 1:2000 GREENWAY ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3020
Practice Address - Country:US
Practice Address - Phone:423-224-6900
Practice Address - Fax:423-224-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility