Healthcare Provider Details

I. General information

NPI: 1518142009
Provider Name (Legal Business Name): REGEN, SMITH AND SMITH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 HIGHWAY 11 W
BLOUNTVILLE TN
37617-3407
US

IV. Provider business mailing address

3737 HIGHWAY 11 W
BLOUNTVILLE TN
37617-3407
US

V. Phone/Fax

Practice location:
  • Phone: 423-354-0222
  • Fax: 423-354-0225
Mailing address:
  • Phone: 423-354-0222
  • Fax: 423-354-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberL 438-017-1726
License Number StateTN

VIII. Authorized Official

Name: MRS. SANDRA SMITH
Title or Position: FRANCHISE OWNER
Credential:
Phone: 423-354-0222