Provider Demographics
NPI:1124039961
Name:ABS LINCS TN INC
Entity Type:Organization
Organization Name:ABS LINCS TN INC
Other - Org Name:CUMBERLAND HALL - CHATTANOOGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:EUREKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAYE
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA, MS
Authorized Official - Phone:423-499-9007
Mailing Address - Street 1:7351 COURAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8404
Mailing Address - Country:US
Mailing Address - Phone:423-499-9007
Mailing Address - Fax:423-499-9757
Practice Address - Street 1:7351 STANDIFER GAP RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8404
Practice Address - Country:US
Practice Address - Phone:423-499-9007
Practice Address - Fax:423-499-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL 2(16)M2-115-1103323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401873700Medicaid
TN0444983Medicaid
PA53-01907140Medicaid
NJ8388202Medicaid
TX1507402Medicaid
GA000928936BMedicaid
DC0339628 00Medicaid
NE=========-99Medicaid
44-4016Medicare ID - Type UnspecifiedPROVIDER NUMBER
DC0339628 00Medicaid