Provider Demographics
NPI:1649420670
Name:JAN ZWARTS VALLEY, LLC
Entity Type:Organization
Organization Name:JAN ZWARTS VALLEY, LLC
Other - Org Name:JZV CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-866-6163
Mailing Address - Street 1:1125 CEDARVIEW LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4075
Mailing Address - Country:US
Mailing Address - Phone:615-975-2050
Mailing Address - Fax:615-465-6518
Practice Address - Street 1:100 BETA DR UNIT A
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3912
Practice Address - Country:US
Practice Address - Phone:615-866-6163
Practice Address - Fax:615-794-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC000001496101Y00000X, 251S00000X
207Q00000X
TNL0000015386251B00000X, 253Z00000X
TNADULT0047-000261QA0600X
TNMD0000042744261QM1300X, 261QP2300X
TNAPN0000011911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN445273Medicaid
TN1000000007398OtherTENNESSEE DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
TNH445273Medicaid
TNI000000024968OtherPSSA LICENSE
TNL000000015386OtherPERSONAL SUPPORT SERVICES AGENCY LICENSE