Provider Demographics
NPI:1285087890
Name:CHATTANOOGA SUPPORTIVE SERVICES, INC.
Entity type:Organization
Organization Name:CHATTANOOGA SUPPORTIVE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARYLIN
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-883-0355
Mailing Address - Street 1:6215 LEE HWY
Mailing Address - Street 2:SUITE 107K
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2916
Mailing Address - Country:US
Mailing Address - Phone:423-475-5647
Mailing Address - Fax:423-475-5648
Practice Address - Street 1:6148 LEE HWY STE 301
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2941
Practice Address - Country:US
Practice Address - Phone:423-883-0355
Practice Address - Fax:423-475-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445463Medicaid