=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104584002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOLANDA'S CARE HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2021
-----------------------------------------------------
Last Update Date | 12/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2417 GARDNER LN
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37207-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-424-8758
-----------------------------------------------------
Fax | 615-649-8287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 78820
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37207-8820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-424-8758
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. YOLANDA NADINE GRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-424-8758
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------