Provider Demographics
NPI:1194046284
Name:HEALTHY SENIOR CLUB
Entity type:Organization
Organization Name:HEALTHY SENIOR CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-415-3856
Mailing Address - Street 1:722 CRESCENT RD
Mailing Address - Street 2:A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1918
Mailing Address - Country:US
Mailing Address - Phone:615-415-3856
Mailing Address - Fax:
Practice Address - Street 1:722 CRESCENT RD
Practice Address - Street 2:A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1918
Practice Address - Country:US
Practice Address - Phone:615-415-3856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies