Healthcare Provider Details

I. General information

NPI: 1649420670
Provider Name (Legal Business Name): JAN ZWARTS VALLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BETA DR UNIT A
FRANKLIN TN
37064-3912
US

IV. Provider business mailing address

1125 CEDARVIEW LN
FRANKLIN TN
37067-4075
US

V. Phone/Fax

Practice location:
  • Phone: 615-866-6163
  • Fax: 615-794-0081
Mailing address:
  • Phone: 615-975-2050
  • Fax: 615-465-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADULT0047-000
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC000001496
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberL0000015386
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC000001496
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberL0000015386
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD0000042744
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000011911
License Number StateTN
# 9
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberMD0000042744
License Number StateTN

VIII. Authorized Official

Name: DR. RAY WHITE
Title or Position: ADMINISTRATOR
Credential: PHD
Phone: 615-866-6163