Provider Demographics
NPI:1790756203
Name:CLEVELAND TENNESSEE HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:CLEVELAND TENNESSEE HOSPITAL COMPANY LLC
Other - Org Name:TENNOVA HEALTHCARE-CLEVELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 198029
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8029
Mailing Address - Country:US
Mailing Address - Phone:423-559-6000
Mailing Address - Fax:423-559-6653
Practice Address - Street 1:2305 CHAMBLISS AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3847
Practice Address - Country:US
Practice Address - Phone:423-559-6000
Practice Address - Fax:423-559-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000006282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440185Medicaid
5000072OtherUNITED HEALTHCARE
0140006296OtherHEALTHSOURCE
1000017OtherBCBS
01CCHTNOtherCOMP HEALTH
030433100OtherBLACK LUNG
GA00136133AMedicaid
A3731201OtherJOHN DEERE
01CCHTNOtherCOMP HEALTH