Healthcare Provider Details

I. General information

NPI: 1609854116
Provider Name (Legal Business Name): EASTER SEALS TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 OLD HICKORY BLVD # 2-260
BRENTWOOD TN
37027-4528
US

IV. Provider business mailing address

750 OLD HICKORY BLVD # 2-260
BRENTWOOD TN
37027-4528
US

V. Phone/Fax

Practice location:
  • Phone: 615-292-6640
  • Fax: 615-251-0994
Mailing address:
  • Phone: 615-292-6640
  • Fax: 615-251-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberL000000009654
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberL000000009653
License Number StateTN

VIII. Authorized Official

Name: RITA S BAUMGARTNER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 615-292-6640