Provider Demographics
NPI:1376758540
Name:BIOS OF TENNESSEE, LLC
Entity Type:Organization
Organization Name:BIOS OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-227-8390
Mailing Address - Street 1:309 E DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4301
Mailing Address - Country:US
Mailing Address - Phone:918-227-8390
Mailing Address - Fax:918-227-8378
Practice Address - Street 1:2855 STAGE VILLAGE CV
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4616
Practice Address - Country:US
Practice Address - Phone:901-388-0258
Practice Address - Fax:901-388-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN05216WOtherCONTRACT NUMBER
TN00B98OtherPROVIDER NUMBER
TNX098OtherLIST NUMBER