Healthcare Provider Details

I. General information

NPI: 1346517463
Provider Name (Legal Business Name): EXCEPTIONAL ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N INDUSTRIAL PARK RD
COALMONT TN
37313-2501
US

IV. Provider business mailing address

23 N INDUSTRIAL PARK RD
COALMONT TN
37313-2501
US

V. Phone/Fax

Practice location:
  • Phone: 931-692-2235
  • Fax: 931-692-2244
Mailing address:
  • Phone: 931-692-2235
  • Fax: 931-692-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberL08065
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberL08065
License Number StateTN

VIII. Authorized Official

Name: MR. WILLIAM R. LINGLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 931-692-2235