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General NPI Number Information
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NPI Number | 1235224650
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Entity Type | Organization
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Legal Business Name | CONTINUCARE HEALTHSERVICES, INC. - WAIVER
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 1501 RIVERSIDE DRIVE SUITE 350
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City | CHATTANOOGA
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State | TN
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Zip | 37406
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Country | US
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Telephone | 423-624-8281
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Fax | 423-624-0133
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Provider Business Mailing Address
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Address Line | 1501 RIVERSIDE DRIVE SUITE 350
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City | CHATTANOOGA
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State | TN
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Zip | 37406
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Country | US
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Telephone | 423-624-8281
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Fax | 423-624-0133
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DONNA L. BOURDON
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Credential |
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Telephone | 423-386-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0000000098
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License Number State | TN
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