Healthcare Provider Details

I. General information

NPI: 1841506425
Provider Name (Legal Business Name): COMMUNITY ECONOMIC AND EMPOWERMENT ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 GALLATIN PIKE SOUTH SUITE 203
MADISON TN
37115-4627
US

IV. Provider business mailing address

1160 GALLATIN PIKE SOUTH SUITE 203
MADISON TN
37115-4627
US

V. Phone/Fax

Practice location:
  • Phone: 615-865-1988
  • Fax: 615-865-1983
Mailing address:
  • Phone: 615-865-1988
  • Fax: 615-865-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JEANNA BERRY
Title or Position: REGISTERED AGENT
Credential:
Phone: 615-865-1988