Provider Demographics
NPI:1457492225
Name:LIFE ACTION TENNESSEE, INC.
Entity Type:Organization
Organization Name:LIFE ACTION TENNESSEE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:ABOYADE-COLE
Authorized Official - Suffix:
Authorized Official - Credentials:R N
Authorized Official - Phone:615-248-4983
Mailing Address - Street 1:475 METROPLEX DR
Mailing Address - Street 2:504
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3153
Mailing Address - Country:US
Mailing Address - Phone:615-248-4983
Mailing Address - Fax:615-248-6956
Practice Address - Street 1:475 METROPLEX DR
Practice Address - Street 2:504
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3153
Practice Address - Country:US
Practice Address - Phone:615-248-4983
Practice Address - Fax:615-248-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL3(32)4M3-126-3655311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility