Provider Demographics
NPI:1609912716
Name:COFFEE COUNTY SENIOR CITIZENS, INC
Entity Type:Organization
Organization Name:COFFEE COUNTY SENIOR CITIZENS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-455-2504
Mailing Address - Street 1:410 N COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3231
Mailing Address - Country:US
Mailing Address - Phone:931-455-2504
Mailing Address - Fax:931-455-2911
Practice Address - Street 1:410 N COLLINS ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3231
Practice Address - Country:US
Practice Address - Phone:931-455-2504
Practice Address - Fax:931-455-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000168Medicaid