Organization
ETLOG MANAGEMENT SERVICE
Active
Parent organization
ETLOG MANAGEMENT SERVICE
Other names
HHOMECare
Organization subpart
Yes
Provider details
NPI number
Legal business name
ETLOG MANAGEMENT SERVICE
Authorized official
DR. YAW OTCHERE-BOATENG MD (CEO)
(423) 677-7040
Entity
Organization
Contact information
Practice address
1005 CARRINGTON CT, KINGSPORT, TN 37660-5694
(423) 677-7040
Mailing address
1005 CARRINGTON CT, KINGSPORT, TN 37660-5694
(423) 677-7040
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251J00000X
Nursing Care Agency
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0208X
Mobile Radiology Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
09/27/2019
Last updated
09/08/2020
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