1124039961 NPI number — ABS LINCS TN INC

Table of content: BERNADETTE STONE (NPI 1326704131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124039961 NPI number — ABS LINCS TN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABS LINCS TN 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:
Provider Other Organization Name Type Code:
6
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:
1124039961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7351 COURAGE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-8404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-499-9007
Provider Business Mailing Address Fax Number:
423-499-9757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7351 STANDIFER GAP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-8404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-499-9007
Provider Business Practice Location Address Fax Number:
423-499-9757
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAYE
Authorized Official First Name:
EUREKA
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICE
Authorized Official Telephone Number:
423-499-9007

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  L 2(16)M2-115-1103 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 401873700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0444983 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53-01907140 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8388202 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1507402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000928936B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0339628 00 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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