Healthcare Provider Details

I. General information

NPI: 1205150836
Provider Name (Legal Business Name): INDEPENDENT LIVING OF TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 RINGGOLD RD SUITE 210
CHATTANOOGA TN
37412-3183
US

IV. Provider business mailing address

5512 RINGGOLD RD SUITE 210
CHATTANOOGA TN
37412-3183
US

V. Phone/Fax

Practice location:
  • Phone: 423-710-3147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number00042731
License Number StateTN

VIII. Authorized Official

Name: TIMOTHY L SWAFFORD
Title or Position: OWNER
Credential:
Phone: 423-710-3147