MEDICARE: LP CLEVELAND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	16	TN
2	313M00000X	Nursing Facility/Intermediate Care Facility	16	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508057456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LP CLEVELAND LLC

Provider Business Mailing Address
First Line	:	12201 BLUEGRASS PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2361
Country	:	US
Telephone Number	:	502-568-7800
Fax Number	:	502-568-7150

Provider Business Practice Location Address
First Line	:	2750 EXECUTIVE PARK NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2722
Country	:	US
Telephone Number	:	423-476-4444
Fax Number	:	423-472-4542

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOHN HARRISON
Credential	:
Telephone Number	:	502-568-7800

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	04/04/2023

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Directions to “LP CLEVELAND LLC ” Practice Location

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