Healthcare Provider Details

I. General information

NPI: 1053676239
Provider Name (Legal Business Name): SWS SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BROADWAY ST
PORTLAND TN
37148-1301
US

IV. Provider business mailing address

201 S BROADWAY ST
PORTLAND TN
37148-1301
US

V. Phone/Fax

Practice location:
  • Phone: 615-945-8401
  • Fax:
Mailing address:
  • Phone: 615-945-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberI000000010107
License Number StateTN

VIII. Authorized Official

Name: SHANNA WHEELER
Title or Position: PRESIDENT
Credential: LPN
Phone: 615-945-8401