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General NPI Number Information
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NPI Number | 1366998718
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Entity Type | Organization
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Legal Business Name | ELCM JOHNSON CITY LEASING LLC
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 2111 E LAKEVIEW DR
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1890
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Country | US
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Telephone | 423-926-1292
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Fax |
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Provider Business Mailing Address
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Address Line | 14241 DALLAS PKWY SUITE 650, BUILDING 3
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City | DALLAS
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State | TX
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Zip | 75254-2936
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | PAUL BOETHEL
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Credential |
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Telephone | 214-535-6071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | ACL0000000376
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License Number State | TN
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