LAVENDER MOUNTAIN SENIOR LIVING INC (NPI# 1124633268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124633268 |
| Entity Type | Organization |
| Organization Name | LAVENDER MOUNTAIN SENIOR LIVING INC |
| Other Organization Name | MAGNOLIA PLACE NURSING AND REHAB CENTER |
| Practice Address |
600 Eagle Lake Trl Rome GA 30165-2207 |
| Practice Telephone | 7067283600 |
| Mailing Telephone | 7067283600 |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2020-09-16 |
| Authorized Official Name | MR. NICK LANCASTER (ADMINISTRATOR) |
| Authorized Official Telephone | 7067283600 |
| Authorized Official Credential | ADMINISTRATOR |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Magnolia Place Nursing and Rehab Center | Other Name - Individual/Organization |
| Street Address |
600 EAGLE LAKE TRL |
| City | ROME |
| State | GA |
| Zip Code | 30165-2207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962003798 | Jessica J Holt | Physical Therapist | 600 Eagle Lake Trl, Rome, GA 30165-2207 | 2020-11-06 |
| 1487260865 | Megan Snider | Physical Therapist | 600 Eagle Lake Trl, Rome, GA 30165-2207 | 2020-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
| Find all providers in zip 30165 | ||||
| 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 |
|---|---|---|---|---|
| 1154457786 | Rpnh, Inc. | Skilled Nursing Facility | 950 Floyd Ave, Rome, NY 13440-4535 | 2007-02-26 |
| 1881767085 | Betsy Ross Rehabilitation Center | Skilled Nursing Facility | 1 Elsie St, Rome, NY 13440-2556 | 2006-11-16 |
| 1508948134 | Forum Group @ Mt. Berry Nursing & Rehabilitation Center, LLC | Skilled Nursing Facility | 2 Three Mile Rd Ne, Rome, GA 30165-9764 | 2006-10-20 |
| 1437231099 | Forum Group At Moran Lake Nursing & Rehabilitation Center, LLC | Skilled Nursing Facility | 139 Moran Lake Rd Ne, Rome, GA 30161-7767 | 2006-10-20 |
| 1093751976 | Winthrop Manor Nursing Home LLC | Skilled Nursing Facility | 12 Chateau Dr Se, Rome, GA 30161-7237 | 2006-06-21 |
| 1104876796 | Sunbridge Retirement Care Associates LLC | Skilled Nursing Facility | 809 S Broad St Sw, Rome, GA 30161-4654 | 2006-05-12 |
| 1760483606 | North Georgia Care Services, Inc | Skilled Nursing Facility | 505 N 5th Ave Sw, Rome, GA 30165-2822 | 2005-08-02 |
| 1295735272 | Chulio Hills Health & Rehab, LLC | Skilled Nursing Facility | 1170 Chulio Rd Se, Rome, GA 30161-4084 | 2005-07-29 |
| 1447257449 | Bethany Operating Co LLC | Skilled Nursing Facility | 800 W Chestnut St, Rome, NY 13440-2364 | 2005-07-05 |
| 1285199430 | Duke Equities LLC | Skilled Nursing Facility | 139 Moran Lake Rd Ne, Rome, GA 30161-7767 | 2019-02-01 |
| Find all providers in ROME | ||||
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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.