Provider Demographics
NPI:1326318460
Name:CLARA BUTLER NURSING AND PERSONAL CARE SERVICE INC. FOR AGING AND DISA
Entity Type:Organization
Organization Name:CLARA BUTLER NURSING AND PERSONAL CARE SERVICE INC. FOR AGING AND DISA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-314-3112
Mailing Address - Street 1:4210 ALTRURIA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-9241
Mailing Address - Country:US
Mailing Address - Phone:901-314-3112
Mailing Address - Fax:901-266-2435
Practice Address - Street 1:4210 ALTRURIA RD STE 102
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-9241
Practice Address - Country:US
Practice Address - Phone:901-314-3112
Practice Address - Fax:901-266-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNS7894253Z00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017814Medicaid