Healthcare Provider Details

I. General information

NPI: 1013211812
Provider Name (Legal Business Name): COLEMANS HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S WATKINS ST
CHATTANOOGA TN
37404-5333
US

IV. Provider business mailing address

2101 S WATKINS ST
CHATTANOOGA TN
37404-5333
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-9120
  • Fax:
Mailing address:
  • Phone: 423-698-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1000000006855
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number1000000006855
License Number StateTN

VIII. Authorized Official

Name: MR. LEONARD NA COLEMAN III
Title or Position: PRESIDENT /DIRECTOR
Credential: BCBS
Phone: 423-698-9120