Healthcare Provider Details

I. General information

NPI: 1093942385
Provider Name (Legal Business Name): LEE STREET DEVELOPERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 LEE AVE
CHATTANOOGA TN
37410-2219
US

IV. Provider business mailing address

5410 LEE AVE
CHATTANOOGA TN
37410-2219
US

V. Phone/Fax

Practice location:
  • Phone: 423-822-7673
  • Fax: 423-821-2468
Mailing address:
  • Phone: 423-822-7673
  • Fax: 423-821-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberACL0000000292
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberACL000000292
License Number StateTN

VIII. Authorized Official

Name: MS. CHERI TANEKA HUDGINS
Title or Position: ADMINISTRATOR
Credential: BBA
Phone: 423-822-7673