Healthcare Provider Details

I. General information

NPI: 1386465151
Provider Name (Legal Business Name): LOVING CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 BEENE ST
SODDY DAISY TN
37379-6910
US

IV. Provider business mailing address

192 BEENE ST
SODDY DAISY TN
37379-6910
US

V. Phone/Fax

Practice location:
  • Phone: 423-805-6093
  • Fax:
Mailing address:
  • Phone: 423-805-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHEVANTE JOHNSON
Title or Position: SECRETARY/ OWNER
Credential:
Phone: 423-805-6093