Healthcare Provider Details

I. General information

NPI: 1013108307
Provider Name (Legal Business Name): LP SPRING CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 HINCH ST
SPRING CITY TN
37381-5217
US

IV. Provider business mailing address

331 HINCH ST
SPRING CITY TN
37381-5217
US

V. Phone/Fax

Practice location:
  • Phone: 423-365-4355
  • Fax: 423-365-5093
Mailing address:
  • Phone: 423-365-4355
  • Fax: 423-365-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number210
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number210
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7440512
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier0445209
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: MR. JOHN HARRISON
Title or Position: AUDIT & REIMBURSEMENT ANALYST
Credential:
Phone: 502-568-7800