Provider Demographics
NPI:1699966986
Name:LP GREENEVILLE LLC
Entity type:Organization
Organization Name:LP GREENEVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:106 HOLT CT
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-6917
Mailing Address - Country:US
Mailing Address - Phone:423-639-0213
Mailing Address - Fax:423-638-4511
Practice Address - Street 1:106 HOLT CT
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-6917
Practice Address - Country:US
Practice Address - Phone:423-639-0213
Practice Address - Fax:423-638-4511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP CR HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445351Medicaid
TN7440318Medicaid
TN7440318Medicaid
TN445351Medicare Oscar/Certification