Provider Demographics
NPI:1104461383
Name:DENISE SENIOR LIVING
Entity type:Organization
Organization Name:DENISE SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-758-4800
Mailing Address - Street 1:1016 CHARLIE DANIELS PKWY
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3064
Mailing Address - Country:US
Mailing Address - Phone:615-758-9300
Mailing Address - Fax:
Practice Address - Street 1:1016 CHARLIE DANIELS PKWY
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3064
Practice Address - Country:US
Practice Address - Phone:615-758-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility