Healthcare Provider Details

I. General information

NPI: 1508057456
Provider Name (Legal Business Name): LP CLEVELAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 EXECUTIVE PARK NW
CLEVELAND TN
37312-2722
US

IV. Provider business mailing address

12201 BLUEGRASS PKWY
LOUISVILLE KY
40299-2361
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-4444
  • Fax: 423-472-4542
Mailing address:
  • Phone: 502-568-7800
  • Fax: 502-568-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number16
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number16
License Number StateTN

VIII. Authorized Official

Name: MR. JOHN HARRISON
Title or Position: CFO
Credential:
Phone: 502-568-7800