Provider Demographics
NPI:1376813642
Name:CENTER FOR EXCELLENCE
Entity Type:Organization
Organization Name:CENTER FOR EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:JABBAR
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:615-310-0287
Mailing Address - Street 1:842 LAVERGNE LN
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-4272
Mailing Address - Country:US
Mailing Address - Phone:615-669-3783
Mailing Address - Fax:270-342-2596
Practice Address - Street 1:842 LAVERGNE LN
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-4272
Practice Address - Country:US
Practice Address - Phone:615-669-3783
Practice Address - Fax:270-342-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI000000009757251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health