=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720105851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT APPALACHIAN INDUSTRIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 04/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 591 E MONTICELLO PIKE
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37756-4109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-663-3818
-----------------------------------------------------
Fax | 423-663-3365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 591 E MONTICELLO PIKE
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37756-4109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-663-9300
-----------------------------------------------------
Fax | 423-663-3365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. LARRY RICHARD WEST
-----------------------------------------------------
Credential | MASTERS DEGREE
-----------------------------------------------------
Telephone | 423-663-3818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | PSS0000000124
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | L 3(20)4M5-066-1387
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------