Healthcare Provider Details

I. General information

NPI: 1194332148
Provider Name (Legal Business Name): TALLEY BOARDING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 SMITH SPRINGS RD
NASHVILLE TN
37217
US

IV. Provider business mailing address

PO BOX 140173, TALLEY BOARDING HOME
NASHVILLE TN
37214
US

V. Phone/Fax

Practice location:
  • Phone: 615-399-5182
  • Fax: 615-232-5143
Mailing address:
  • Phone: 615-957-8874
  • Fax: 615-232-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KELVIN SPENCER TALLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 615-957-8874