1447532205 NPI number — TT & S FAMILY FOUNDATION INC

Table of content: (NPI 1447532205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447532205 NPI number — TT & S FAMILY FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TT & S FAMILY FOUNDATION 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:
AZAELA TRACE ASSISTED LIVING
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:
1447532205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 132
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD HICKORY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37138-0132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-915-4074
Provider Business Mailing Address Fax Number:
615-942-6392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 PLUS PARK BLVD
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:
37217-1098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-915-4074
Provider Business Practice Location Address Fax Number:
615-942-6342
Provider Enumeration Date:
09/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DEES-JOHNSON
Authorized Official First Name:
THELMA
Authorized Official Middle Name:
Authorized Official Title or Position:
LPC-MHSP
Authorized Official Telephone Number:
61591504074

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2111 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 2111 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 3847 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 2111 , 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: H445718 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5442020 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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