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General NPI Number Information
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NPI Number | 1346027208
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Entity Type | Organization
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Legal Business Name | COOKEVILLE SENIOR LIVING LLC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 1250 CEDAR HILLS DR
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City | COOKEVILLE
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State | TN
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Zip | 38506-4347
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Country | US
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Telephone | 931-526-9108
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Fax | 931-372-2856
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Provider Business Mailing Address
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Address Line | 1250 CEDAR HILLS DR
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City | COOKEVILLE
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State | TN
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Zip | 38506-4347
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Country | US
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Telephone | 931-526-9108
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Fax | 931-372-2856
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MEGAN BROOK LEE
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Credential | LPN
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Telephone | 931-526-9108
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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 |
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License Number State |
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