Provider Demographics
NPI:1366841348
Name:BAMBINO INC DBA COMFORT KEEPERS
Entity Type:Organization
Organization Name:BAMBINO INC DBA COMFORT KEEPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-246-0100
Mailing Address - Street 1:1134 MORELAND DR STE A
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-6206
Mailing Address - Country:US
Mailing Address - Phone:423-246-0100
Mailing Address - Fax:423-246-0300
Practice Address - Street 1:1134 MORELAND DR STE A
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-6206
Practice Address - Country:US
Practice Address - Phone:423-246-0100
Practice Address - Fax:423-246-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL00000013458253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445772Medicaid