Provider Demographics
NPI:1588629950
Name:J.W. CARELL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:J.W. CARELL ENTERPRISES, LLC
Other - Org Name:CAREALL HOME CARE SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-781-0666
Mailing Address - Street 1:118 MABRY HOOD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2219
Mailing Address - Country:US
Mailing Address - Phone:865-531-9988
Mailing Address - Fax:865-531-9949
Practice Address - Street 1:118 MABRY HOOD RD
Practice Address - Street 2:STE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2219
Practice Address - Country:US
Practice Address - Phone:865-531-9988
Practice Address - Fax:865-531-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000131251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN447523Medicaid
TN4167958OtherBC/BS OF TENNESSEE
TN447523Medicare ID - Type UnspecifiedPROVIDER NUMBER KNOXVILLE