Healthcare Provider Details

I. General information

NPI: 1013113331
Provider Name (Legal Business Name): CDE ONSITE SENIOR SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2007
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13143 EL CAMINO LN
KNOXVILLE TN
37932-3512
US

IV. Provider business mailing address

13143 EL CAMINO LN
KNOXVILLE TN
37932-3512
US

V. Phone/Fax

Practice location:
  • Phone: 865-256-7444
  • Fax: 800-303-0672
Mailing address:
  • Phone: 865-256-7444
  • Fax: 800-303-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberL000000004354
License Number StateTN

VIII. Authorized Official

Name: MRS. PENNY DIANE DISNEY
Title or Position: COO
Credential:
Phone: 865-585-0403