Healthcare Provider Details

I. General information

NPI: 1437364619
Provider Name (Legal Business Name): BIOS OF TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 COLUMBIA PIKE
THOMPSONS STATION TN
37179-5206
US

IV. Provider business mailing address

309 E DEWEY AVE
SAPULPA OK
74066-4301
US

V. Phone/Fax

Practice location:
  • Phone: 615-599-1125
  • Fax: 615-599-6525
Mailing address:
  • Phone: 918-227-8390
  • Fax: 918-227-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateTN

VIII. Authorized Official

Name: LORI MOUSE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 918-227-8390