Provider Demographics
NPI:1235224650
Name:CONTINUCARE HEALTHSERVICES, INC. - WAIVER
Entity Type:Organization
Organization Name:CONTINUCARE HEALTHSERVICES, INC. - WAIVER
Other - Org Name:CONTINUCARE HEALTHSERVICES, INC. - DMRS WAIVER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOURDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-386-1000
Mailing Address - Street 1:1501 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406
Mailing Address - Country:US
Mailing Address - Phone:423-624-8281
Mailing Address - Fax:423-624-0133
Practice Address - Street 1:1501 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406
Practice Address - Country:US
Practice Address - Phone:423-624-8281
Practice Address - Fax:423-624-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000098251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN004444OtherDMRS WAIVER
TN0447471Medicaid
447471Medicare ID - Type Unspecified