1366839359 NPI number — KERNS ENTERPRISES, LLC

Table of content: (NPI 1366839359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366839359 NPI number — KERNS ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERNS ENTERPRISES, LLC
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:
PREFERRED CARE AT HOME
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:
1366839359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 MCCALLIE AVE
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37404-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-531-8696
Provider Business Mailing Address Fax Number:
423-475-5961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 MCCALLIE AVE
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37404-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-531-8696
Provider Business Practice Location Address Fax Number:
423-475-5961
Provider Enumeration Date:
04/17/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KERNS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
OWNER AND PRESIDENT
Authorized Official Telephone Number:
423-531-8696

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  L000000015316 , 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)