Healthcare Provider Details

I. General information

NPI: 1386617462
Provider Name (Legal Business Name): ALCOA SENIOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 CALDERWOOD ST. SUITE C2
ALCOA TN
37701
US

IV. Provider business mailing address

2445 CALDERWOOD ST. SUITE C2
ALCOA TN
37701
US

V. Phone/Fax

Practice location:
  • Phone: 865-681-2681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENDA ELLIS
Title or Position: PRIVACY OFFICER
Credential: RHIT
Phone: 865-549-2121