1215364633 NPI number — AMERICA CARES TRUST, INC

Table of content: (NPI 1215364633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215364633 NPI number — AMERICA CARES TRUST, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICA CARES TRUST, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICA CARES TRUST
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215364633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5247 HARDING PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37217-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-739-3371
Provider Business Mailing Address Fax Number:
615-486-4103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5247 HARDING PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37217-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-739-3371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAW
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
615-739-3371

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 48969 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1532934 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".