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General NPI Number Information
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NPI Number | 1194201434
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Entity Type | Organization
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Legal Business Name | DOMINION SENIOR LIVNING OF CROSSVILLE
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 887 WOODLAWN RD
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City | CROSSVILLE
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State | TN
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Zip | 38555-5449
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Country | US
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Telephone | 931-287-2557
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Fax |
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Provider Business Mailing Address
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Address Line | 887 WOODLAWN RD
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City | CROSSVILLE
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State | TN
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Zip | 38555-5449
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Country | US
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Telephone | 931-287-2557
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Fax | 931-484-9041
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KELLIE DODSON
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Credential |
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Telephone | 931-287-2557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ACL0000000422
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License Number State | TN
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