1366438160 NPI number — SAINT BARNABAS NURSING HOME

Table of content: (NPI 1366438160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366438160 NPI number — SAINT BARNABAS NURSING HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT BARNABAS NURSING HOME
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:
SAINT BARNABAS SENIOR LIVING SERVICES
Provider Other Organization Name Type Code:
3
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:
1366438160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 PINE ST
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:
37402-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-267-3764
Provider Business Mailing Address Fax Number:
423-756-6711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 PINE ST
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:
37402-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-267-3764
Provider Business Practice Location Address Fax Number:
423-756-6711
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WATTS
Authorized Official First Name:
TEDD
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
423-267-3764

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0000000113 , 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: 7440184 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com