Healthcare Provider Details

I. General information

NPI: 1619328432
Provider Name (Legal Business Name): STAND BY ME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NASHBORO GREENS WAY
NASHVILLE TN
37217-3931
US

IV. Provider business mailing address

304 NASHBORO GREENS WAY
NASHVILLE TN
37217-3931
US

V. Phone/Fax

Practice location:
  • Phone: 615-423-1361
  • Fax:
Mailing address:
  • Phone: 615-423-1361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number192897
License Number StateTN

VIII. Authorized Official

Name: AHMED JAMA
Title or Position: OWNER
Credential:
Phone: 615-423-1361