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General NPI Number Information
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NPI Number | 1700762572
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Entity Type | Organization
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Legal Business Name | FAIRFIELD GLADE OF TENNESSEE, LLC
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 100 SAMARITAN WAY
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City | CROSSVILLE
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State | TN
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Zip | 38558-1401
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Country | US
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Telephone | 931-710-0908
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Fax |
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Provider Business Mailing Address
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Address Line | 2334 41ST ST
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City | WILMINGTON
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State | NC
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Zip | 28403-5502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, LIBERTY LIVING MANAGEMEN
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Name | WILLIAM B PURVIS
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Credential |
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Telephone | 910-815-3122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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