MEDICARE: JAN ZWARTS VALLEY, LLC

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	261QA0600X	Adult Day Care Clinic/Center	ADULT0047-000	TN
2	101Y00000X	Counselor	LPC000001496	TN
3	207Q00000X	Family Medicine Physician
4	251B00000X	Case Management Agency	L0000015386	TN
5	251S00000X	Community/Behavioral Health Agency	LPC000001496	TN
6	253Z00000X	In Home Supportive Care Agency	L0000015386	TN
7	261QP2300X	Primary Care Clinic/Center	MD0000042744	TN
8	363L00000X	Nurse Practitioner	APN0000011911	TN
9	261QM1300X	Multi-Specialty Clinic/Center	MD0000042744	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
2	1000000007398	OTHER	TN	TENNESSEE DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	I000000024968	OTHER	TN	PSSA LICENSE
5	L000000015386	OTHER	TN	PERSONAL SUPPORT SERVICES AGENCY LICENSE

General Provider Information

NPI Number	:	1649420670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAN ZWARTS VALLEY, LLC

Provider Business Mailing Address
First Line	:	1125 CEDARVIEW LN
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-4075
Country	:	US
Telephone Number	:	615-975-2050
Fax Number	:	615-465-6518

Provider Business Practice Location Address
First Line	:	100 BETA DR UNIT A
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-3912
Country	:	US
Telephone Number	:	615-866-6163
Fax Number	:	615-794-0081

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. RAY WHITE
Credential	:	PHD
Telephone Number	:	615-866-6163

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	09/01/2019

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