Healthcare Provider Details

I. General information

NPI: 1457492225
Provider Name (Legal Business Name): LIFE ACTION TENNESSEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 METROPLEX DR 504
NASHVILLE TN
37211-3153
US

IV. Provider business mailing address

475 METROPLEX DR 504
NASHVILLE TN
37211-3153
US

V. Phone/Fax

Practice location:
  • Phone: 615-248-4983
  • Fax: 615-248-6956
Mailing address:
  • Phone: 615-248-4983
  • Fax: 615-248-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberL3(32)4M3-126-3655
License Number StateTN

VIII. Authorized Official

Name: MRS. DEBORAH ROCHELLE ABOYADE-COLE
Title or Position: EXECUTIVE DIRECTOR
Credential: R. N.
Phone: 615-248-4983