Healthcare Provider Details

I. General information

NPI: 1851423792
Provider Name (Legal Business Name): MITCHELL MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 S COLLEGE ST
LEBANON TN
37087-3643
US

IV. Provider business mailing address

152 S COLLEGE ST
LEBANON TN
37087-3643
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-2882
  • Fax: 615-449-9565
Mailing address:
  • Phone: 615-444-2882
  • Fax: 615-449-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0000000300
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000300
License Number StateTN

VIII. Authorized Official

Name: MRS. SUSAN THOMAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 615-444-2882