Healthcare Provider Details

I. General information

NPI: 1114854585
Provider Name (Legal Business Name): CROSSVILLE TN OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 WAYNE AVE
CROSSVILLE TN
38555-4206
US

IV. Provider business mailing address

456 WAYNE AVE
CROSSVILLE TN
38555-4206
US

V. Phone/Fax

Practice location:
  • Phone: 931-484-6129
  • Fax:
Mailing address:
  • Phone: 931-484-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LIEBERMAN
Title or Position: VICE PRESIDENT OF PROCUREMENT
Credential:
Phone: 516-855-5504