Healthcare Provider Details

I. General information

NPI: 1215163761
Provider Name (Legal Business Name): KELLY'S ADULT DAY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RAULSTON ST
CHATTANOOGA TN
37404-1432
US

IV. Provider business mailing address

2000 RAULSTON ST
CHATTANOOGA TN
37404-1432
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-2611
  • Fax: 423-698-2911
Mailing address:
  • Phone: 423-698-2611
  • Fax: 423-698-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberC-25A
License Number StateTN

VIII. Authorized Official

Name: MS. SHARON JO KELLY
Title or Position: CEO
Credential: RN
Phone: 423-698-2611