Provider Demographics
NPI:1619253853
Name:CHILDREN'S HOME CHAMBLISS SHELTER
Entity Type:Organization
Organization Name:CHILDREN'S HOME CHAMBLISS SHELTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:ACORD
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:423-698-2456
Mailing Address - Street 1:315 GILLESPIE RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3105
Mailing Address - Country:US
Mailing Address - Phone:423-698-2456
Mailing Address - Fax:423-242-1670
Practice Address - Street 1:315 GILLESPIE RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3105
Practice Address - Country:US
Practice Address - Phone:423-698-2456
Practice Address - Fax:423-242-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSO/10864A251B00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency