1912278110 NPI number — JACKSON HOMECARE MINISTRIES 1

Table of content: CHRISTINE J CHILDERS PHD (NPI 1720032113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912278110 NPI number — JACKSON HOMECARE MINISTRIES 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON HOMECARE MINISTRIES 1
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:
1912278110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 RURAL HILL CT
Provider Second Line Business Mailing Address:
B
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37217-3815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-642-4665
Provider Business Mailing Address Fax Number:
615-367-5007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 RURAL HILL RD
Provider Second Line Business Practice Location Address:
323 RURAL HILL RD
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37217-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-642-4665
Provider Business Practice Location Address Fax Number:
615-367-5007
Provider Enumeration Date:
01/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
L V
Authorized Official Middle Name:
NONE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
615-642-4665

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  L000000012559;12560; , 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: ALYSSA44 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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