1912119199 NPI number — CAPABILITIES FOR LIVING, LLC

Table of content: (NPI 1912119199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912119199 NPI number — CAPABILITIES FOR LIVING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPABILITIES FOR LIVING, 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:
Provider Other Organization Name Type Code:
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:
1912119199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
748 WALNUT KNOLL LN
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38018-3110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-507-4780
Provider Business Mailing Address Fax Number:
901-507-4786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
748 WALNUT KNOLL LN
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38018-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-507-4780
Provider Business Practice Location Address Fax Number:
901-507-4786
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
901-507-4780

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  OT0000000002 , 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: 36555 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4075307 . This is a "BCBS CLINIC ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4075308 . This is a "SANDY FLETCHALL BCBS ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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