MEDICARE: GOOD NEIGHBORS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	L000000003799	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083841589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD NEIGHBORS, INC.

Provider Business Mailing Address
First Line	:	737 EAST 10TH STREET
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-0159
Country	:	US
Telephone Number	:	423-266-1772
Fax Number	:	423-266-1773

Provider Business Practice Location Address
First Line	:	737 EAST 10TH STREET
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-0159
Country	:	US
Telephone Number	:	423-266-1772
Fax Number	:	423-266-1773

Authorized Official
Title or Position	:	CHAIRMAN OF BOARD
Name	:	MR. EDWARD FLETCHER
Credential	:
Telephone Number	:	423-266-1772

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	06/11/2009

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Directions to “GOOD NEIGHBORS, INC. ” Practice Location

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