MEDICARE: SCENIC CITY ASSISTANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1245015809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCENIC CITY ASSISTANCE LLC

Provider Business Mailing Address
First Line	:	5805 LEE HWY STE 302
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3546
Country	:	US
Telephone Number	:	423-805-9022
Fax Number	:	423-805-9124

Provider Business Practice Location Address
First Line	:	5805 LEE HWY STE 302
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3546
Country	:	US
Telephone Number	:	423-805-9022
Fax Number	:	423-805-9124

Authorized Official
Title or Position	:	OWNER
Name	:	DEVIN ANDREW GORE
Credential	:
Telephone Number	:	423-805-9022

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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