=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043597776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOR O INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2011
-----------------------------------------------------
Last Update Date | 11/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2412 W ANDREW JOHNSON HWY SUITE E
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-587-5800
-----------------------------------------------------
Fax | 423-587-5818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2412 W ANDREW JOHNSON HWY SUITE E
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-587-5800
-----------------------------------------------------
Fax | 423-587-5818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE SECRETARY/FRANCHISE OWNER
-----------------------------------------------------
Name | CHRISTINA O'BRIEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-587-5800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | L000000008538
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------