Healthcare Provider Details

I. General information

NPI: 1285936880
Provider Name (Legal Business Name): ABOVE AND BEYOND RESIDENTIAL LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 10TH AVE N STE 122
NASHVILLE TN
37203-3498
US

IV. Provider business mailing address

315 10TH AVE N STE 122
NASHVILLE TN
37203-3498
US

V. Phone/Fax

Practice location:
  • Phone: 615-254-1811
  • Fax: 615-254-2818
Mailing address:
  • Phone: 615-254-1811
  • Fax: 615-254-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1000000006337
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIE JACKSON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 615-254-1811