Organization
LIFE CARE AT HOME OF TENNESSEE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE JOHNSON (DIRECTOR OF ACCOUNTING)
(423) 473-5257
Entity
Organization
Contact information
Practice address
7625 HAMILTON PARK DR, STE 16, CHATTANOOGA, TN 37421-1188
(423) 510-1500
(423) 510-1560
Mailing address
3001 KEITH ST NW, CLEVELAND, TN 37312-3713
(423) 473-5256
(423) 559-8356
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
0000000109
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3062149
BLUECROSS BLUESHIELD PROV
TN
Enumeration date
05/23/2005
Last updated
03/06/2013
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