=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447527643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUBBA'S BETTER LIFE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2011
-----------------------------------------------------
Last Update Date | 11/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 CENTERVIEW RD
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38372-7215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-925-4905
-----------------------------------------------------
Fax | 731-925-4906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 CENTERVIEW RD
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38372-7215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-925-4905
-----------------------------------------------------
Fax | 731-925-4906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN MICHAEL MORRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 731-925-4905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------