Healthcare Provider Details

I. General information

NPI: 1063326718
Provider Name (Legal Business Name): CLOUD NINE ELITE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLUMBIA DR
OAK RIDGE TN
37830-7720
US

IV. Provider business mailing address

105 COLUMBIA DR
OAK RIDGE TN
37830-7720
US

V. Phone/Fax

Practice location:
  • Phone: 865-339-3437
  • Fax:
Mailing address:
  • Phone: 865-339-3437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANDIE MASTON
Title or Position: OWNER
Credential:
Phone: 865-339-3437