Provider Demographics
NPI:1699872879
Name:TRI-AGE ADVENTURES, INC.
Entity type:Organization
Organization Name:TRI-AGE ADVENTURES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-666-3170
Mailing Address - Street 1:405 TIMES AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1247
Mailing Address - Country:US
Mailing Address - Phone:615-666-3170
Mailing Address - Fax:615-666-9146
Practice Address - Street 1:405 TIMES AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1247
Practice Address - Country:US
Practice Address - Phone:615-666-3170
Practice Address - Fax:615-666-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN168314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445410Medicaid
TN7440570Medicaid
TN0445410Medicaid