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General NPI Number Information
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NPI Number | 1538308432
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Entity Type | Organization
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Legal Business Name | NURTURED LIVING OF CHATTANOOGA
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 1301 WOODMORE LANE
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City | CHATTANOOGA
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State | TN
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Zip | 37411
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Country | US
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Telephone | 423-624-2060
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Fax | 423-624-2055
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Provider Business Mailing Address
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Address Line | 1301 WOODMORE LANE
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City | CHATTANOOGA
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State | TN
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Zip | 37411
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Country | US
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Telephone | 423-624-2060
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Fax | 423-624-2055
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ANDREA G JACKSON
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Credential | LICENSED PRACTICAL N
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Telephone | 423-304-1847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 1438-058-9179
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License Number State | TN
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