Provider Demographics
NPI:1679640627
Name:ALEXIAN BROTHERS COMMUNITY SERVICES OF TENNESSEE
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS COMMUNITY SERVICES OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, ELDERLY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-771-5800
Mailing Address - Street 1:425 CUMBERLAND ST
Mailing Address - Street 2:STE. 110
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1905
Mailing Address - Country:US
Mailing Address - Phone:314-771-5800
Mailing Address - Fax:
Practice Address - Street 1:425 CUMBERLAND ST
Practice Address - Street 2:STE. 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1905
Practice Address - Country:US
Practice Address - Phone:423-698-0802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
44-27743OtherNCPDP
TN7440700Medicaid
H4402Medicare ID - Type Unspecified