Provider Demographics
NPI:1013211812
Name:COLEMANS HOME INC.
Entity Type:Organization
Organization Name:COLEMANS HOME INC.
Other - Org Name:COLEMANS PERSONAL SUPPORT SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT /DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:NA
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:BCBS
Authorized Official - Phone:423-698-9120
Mailing Address - Street 1:2101 S WATKINS ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-5333
Mailing Address - Country:US
Mailing Address - Phone:423-698-9120
Mailing Address - Fax:
Practice Address - Street 1:2101 S WATKINS ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-5333
Practice Address - Country:US
Practice Address - Phone:423-698-9120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000006855253Z00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445456OtherBUREAU OF TENNCARE