LAKEBRIDGE A WATERS COMMUNITY LLC (NPI# 1043763592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043763592 |
| Entity Type | Organization |
| Organization Name | LAKEBRIDGE A WATERS COMMUNITY LLC |
| Practice Address |
115 Woodlawn Dr Johnson City TN 37604-5978 |
| Practice Telephone | 4239750095 |
| Practice Fax Number | 4239280358 |
| Mailing Telephone | 4239750095 |
| Mailing Fax Number | 4239280358 |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2016-08-02 |
| Authorized Official Name | MOISHE GUBIN (MEMBER) |
| Authorized Official Telephone | 7084491900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Street Address |
115 WOODLAWN DR |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-5978 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245216910 | Management Care Corporation | Skilled Nursing Facility | 115 Woodlawn Dr, Johnson City, TN 37604-5978 | 2005-12-15 |
| 1598248320 | Emerald Taylor Harrell | Physical Therapist | 115 Woodlawn Dr, Johnson City, TN 37604-5978 | 2018-09-07 |
| 1962828137 | Medpsych Inc. PC | Specialist | 115 Woodlawn Dr, Johnson City, TN 37604-5978 | 2014-03-12 |
| 1669626800 | Vikki Burleson-bryant | Nurse Practitioner | 115 Woodlawn Dr, Johnson City, TN 37604-5978 | 2008-11-14 |
| 1407933443 | Lakebridge Medical Investors, LLC | Nursing Facility/Intermediate Care Facility | 115 Woodlawn Dr, Johnson City, TN 37604-5978 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558984278 | Slp Johnson City LLC | Skilled Nursing Facility | 206 Haley Rd, Johnson City, TX 78636-4617 | 2020-05-28 |
| 1932262334 | Asbury, Inc. | Skilled Nursing Facility | 105 W Myrtle Ave, Johnson City, TN 37604-5633 | 2006-12-18 |
| 1366472052 | Umh Jgj Corp | Skilled Nursing Facility | 286 Deyo Hill Rd, Johnson City, NY 13790-5110 | 2006-07-05 |
| 1699711192 | Nhc Healthcare-johnson City LLC | Skilled Nursing Facility | 3209 Bristol Hwy, Johnson City, TN 37601-1515 | 2006-06-22 |
| 1245216910 | Management Care Corporation | Skilled Nursing Facility | 115 Woodlawn Dr, Johnson City, TN 37604-5978 | 2005-12-15 |
| 1285615682 | Susquehanna Nursing & Rehabilitation Center, LLC | Skilled Nursing Facility | 282 Riverside Dr, Johnson City, NY 13790-2727 | 2005-11-11 |
| 1841743291 | The Waters of Johnson City LLC | Skilled Nursing Facility | 140 Technology Ln, Johnson City, TN 37604-2004 | 2016-08-02 |
| 1366835209 | Caregivers | Skilled Nursing Facility | 260 Harry L Dr, Johnson City, NY 13790-1493 | 2015-03-17 |
| 1548568082 | Mountain States Health Alliance | Skilled Nursing Facility | 2511 Wesley St, Johnson City, TN 37601-1723 | 2011-03-08 |
| 1841393329 | Mountain States Health Alliance | Skilled Nursing Facility | 400 N State of Franklin Rd, Johnson City, TN 37604-6035 | 2006-09-07 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.