Healthcare Provider Details

I. General information

NPI: 1568999381
Provider Name (Legal Business Name): ACBC VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SIMMONS ST
MARYVILLE TN
37801-4750
US

IV. Provider business mailing address

1038 WILDER CHAPEL LN
MARYVILLE TN
37804-3786
US

V. Phone/Fax

Practice location:
  • Phone: 865-210-8842
  • Fax:
Mailing address:
  • Phone: 865-214-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberI000000018774
License Number StateTN

VIII. Authorized Official

Name: MR. BENJAMIN M CRAWLEY
Title or Position: OWNER
Credential:
Phone: 865-214-7712