Provider Demographics
NPI:1215253984
Name:STONECREST ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:STONECREST ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANETA
Authorized Official - Middle Name:GAE
Authorized Official - Last Name:SHOULDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:615-666-6400
Mailing Address - Street 1:2861 HIGHWAY 52 E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-6029
Mailing Address - Country:US
Mailing Address - Phone:615-666-6400
Mailing Address - Fax:615-666-6406
Practice Address - Street 1:2861 HIGHWAY 52 E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-6029
Practice Address - Country:US
Practice Address - Phone:615-666-6400
Practice Address - Fax:615-666-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000302310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility