VICTORIAN SQUARE, LLC (NPI# 1710180955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710180955 |
| Entity Type | Organization |
| Organization Name | VICTORIAN SQUARE, LLC |
| Other Organization Name | VICTORIAN SQUARE ASSISTED LIVING FACILITY |
| Practice Address |
241 S Chamberlain Ave Rockwood TN 37854-6542 |
| Mailing Address |
12933 W Highway 42 Prospect KY 40059-9107 |
| Practice Telephone | 8653541133 |
| Practice Fax Number | 8653546371 |
| Mailing Telephone | 5022288131 |
| Mailing Fax Number | 5022281940 |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2013-01-24 |
| Authorized Official Name | MR. RALPH H BELLANDE (MANAGING PARTNER) |
| Authorized Official Telephone | 5022288131 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
ACL0000000147 | TN | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | TENNCARE/MEDICAID | 4262690 | 01 |
| Other Name | Type Code |
|---|---|
| Victorian Square Assisted Living Facility | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | VICTORIAN SQUARE, LLC | 46 North Chestnut Street, New Paltz, New York 12561 |
| Colorado Business Entities | VICTORIAN SQUARE, LLC | 625 E. Hyman Avenue, Suite 201, Aspen, CO 81611 |
| Street Address |
241 S CHAMBERLAIN AVE |
| City | ROCKWOOD |
| State | TN |
| Zip Code | 37854-6542 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245500917 | Assurance Professional Billing Services | Specialist | 236 Burke Mill Rd, Rockwood, TN 37854 | 2012-01-11 |
| 1639407489 | Robert Sloan Hicks Jr. | Pharmacist | 225 West Rockwood St., Live and Let Live Drug Store, Rockwood, TN 37854 | 2009-12-04 |
| 1255477741 | Janet Eldridge Isham | Licensed Practical Nurse | 1362 N. Gateway Ave, Rockwood, TN 37854 | 2007-01-30 |
| 1154439271 | James Larry Brewer | Dentist | 1124 N Gateway Ave, Rockwood, TN 37854 | 2006-08-28 |
| 1750808093 | Cynthia Dawn Clark | Nurse Practitioner | 1420 N Gateway Ave, Rockwood, TN 37854 | 2017-08-28 |
| 1568772754 | Summit Medical Group, Pllc | Internal Medicine | 1420 North Gateway Ave, Rockwood, TN 37854 | 2010-10-21 |
| 1841348547 | Darrell Eugene Cates Jr. | Dentist | 1546 Gateway Ave., Rockwood, TN 37854-0003 | 2007-01-08 |
| 1033264411 | Sherry G Hill | Pharmacist | 225 W Rockwood St, Rockwood, TN 37854-2243 | 2007-01-24 |
| 1487003455 | Live and Let Live Drug Store, Inc | Durable Medical Equipment & Medical Supplies | 225 W Rockwood St, Rockwood, TN 37854-2243 | 2016-06-09 |
| 1851434666 | Jessica Ruthanne Kilgore | Pharmacist | 225 W Rockwood St, Rockwood, TN 37854-2243 | 2007-02-14 |
| Find all providers in zip 37854 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750905386 | Memanabel Assisted Living Home Care | Assisted Living Facility | 5161 Pebble Creek Dr, Antioch, TN 37013-1871 | 2020-05-29 |
| 1154880557 | Wellington Manor, LLC | Assisted Living Facility | 375 Hendrick Drive, Newport, TN 37821-5344 | 2019-03-15 |
| 1134699242 | Fountain Springs Healthcare Corp | Assisted Living Facility | 637 Lake Terrace Dr, Nashville, TN 37217-4212 | 2018-12-01 |
| 1720580624 | Renee's House of Care | Assisted Living Facility | 2068 Lee Cv, Memphis, TN 38127-3322 | 2018-03-06 |
| 1225568389 | Balance Homecare LLC | Assisted Living Facility | 2611 Herman St, Nashville, TN 37208-3234 | 2017-06-12 |
| 1700281524 | Trucare Transformation | Assisted Living Facility | 607 Neill Ave, Nashville, TN 37206-3923 | 2014-10-23 |
| 1497163760 | Comer House of Nashville LLC | Assisted Living Facility | 1603 14th Ave N, Nashville, TN 37208-2034 | 2014-07-30 |
| 1821337866 | Leann Care LLC | Assisted Living Facility | 33 Rawlig Wood Cove Ave, Jackson, TN 38305 | 2013-02-12 |
| 1588994560 | Serenity Homes LLC | Assisted Living Facility | 3313 Cotton Bale Cv, Memphis, TN 38119-8971 | 2010-01-13 |
| 1770760829 | Davidson County Assisted Living LLC | Assisted Living Facility | 6961 Highway 70 S, Nashville, TN 37221-2204 | 2008-01-30 |
| Find all providers with the same taxonomy | ||||
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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.