SOUTHERN MANOR LIVING CENTERS, LLC
NPI 1619274644
Assisted Living Facility in Fayetteville, TN

Q: What is Southern Manor Living Centers, LLC's NPI number?

The NPI number for Southern Manor Living Centers, LLC is 1619274644. It was assigned to this organization in the NPPES registry on February 28, 2011.

Q: What is Southern Manor Living Centers, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since February 28, 2011

115 MEDICAL CENTER BLVD, FAYETTEVILLE, TN 37334(931) 433-5000(931) 433-6908 Get Directions Write a Review

NPPES record last updated: February 28, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Southern Manor Living Centers, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN MANOR LIVING CENTERS, LLC (NPI 1619274644) is a healthcare organization registered as an assisted living facility in Fayetteville, Tennessee and active in the NPI registry since February 2011. The organization lists Cheryl Pendergrass, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1619274644

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameSOUTHERN MANOR LIVING CENTERS, LLC

Location Address115 MEDICAL CENTER BLVDFayetteville, TN 37334-2689

Mailing Address115 Medical Center BlvdFayetteville, TN 37334-2689 · (931) 433-5000 · Fax (931) 433-6908

Phone(931) 433-5000

Fax(931) 433-6908

Organization SubpartNo

Authorized OfficialCheryl PendergrassExecutive Director · (931) 433-5000

Enumeration DateFebruary 28, 2011

✔ NPI 1619274644 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

License✔ Licensed in TN · ACL0000000215

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

115 MEDICAL CENTER BLVD, Fayetteville, TN 37334

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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LINCOLN AL OPCO LLC

Assisted Living Facility

115 MEDICAL CENTER BLVD
FAYETTEVILLE, TN 37334

Lincoln County (931) 433-5000

FAYETTEVILLE OPERATOR LLC

Assisted Living Facility

115 MEDICAL CENTER BLVD
FAYETTEVILLE, TN 37334

Lincoln County (931) 433-5000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Manor Living Centers, LLC's NPI number?

The NPI number for Southern Manor Living Centers, LLC is 1619274644. It was assigned to this organization in the NPPES registry on February 28, 2011.

Where is Southern Manor Living Centers, LLC located?

Southern Manor Living Centers, LLC is located at 115 Medical Center Blvd, Fayetteville, TN 37334. The listed phone number is (931) 433-5000.

What is Southern Manor Living Centers, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Southern Manor Living Centers, LLC was last updated on February 28, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.