Healthcare Provider Details

I. General information

NPI: 1609977909
Provider Name (Legal Business Name): ALEXIAN BROTHERS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CUMBERLAND ST
CHATTANOOGA TN
37404-1905
US

IV. Provider business mailing address

425 CUMBERLAND ST
CHATTANOOGA TN
37404-1905
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-0802
  • Fax: 423-697-1752
Mailing address:
  • Phone: 423-698-0802
  • Fax: 423-697-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number12194
License Number StateTN

VIII. Authorized Official

Name: MRS. STEPHANIE SHERIDAN
Title or Position: NURSE PRACTITIONER
Credential: ANP, MSN, CDN
Phone: 423-698-0802