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General NPI Number Information
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NPI Number | 1437038353
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Entity Type | Organization
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Legal Business Name | DOMINION SENIOR LIVING OF BRISTOL
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 425 SHELBY LN
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City | BRISTOL
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State | TN
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Zip | 37620-5840
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Country | US
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Telephone | 423-797-8080
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Fax | 423-217-1780
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Provider Business Mailing Address
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Address Line | 425 SHELBY LN
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City | BRISTOL
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State | TN
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Zip | 37620-5840
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Country | US
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Telephone | 423-797-8080
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Fax | 423-217-1780
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LORI GOODMAN
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Credential | ED
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Telephone | 423-797-8080
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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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