Healthcare Provider Details

I. General information

NPI: 1912160078
Provider Name (Legal Business Name): ST BARNABAS APARTMENTS ASSISTED LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 SISKIN DR
CHATTANOOGA TN
37403-1309
US

IV. Provider business mailing address

300 W 6TH ST
CHATTANOOGA TN
37402-1111
US

V. Phone/Fax

Practice location:
  • Phone: 423-847-4124
  • Fax: 423-847-4139
Mailing address:
  • Phone: 423-847-4600
  • Fax: 423-847-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberACL0000000134
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DAN OWNBY
Title or Position: CONTROLLER
Credential:
Phone: 423-847-4124