Provider Demographics
NPI:1891064002
Name:TENNESSEE PERSONAL ASSISTANCE, INC
Entity Type:Organization
Organization Name:TENNESSEE PERSONAL ASSISTANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SWEDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWENDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-331-6200
Mailing Address - Street 1:475 METROPLEX DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3153
Mailing Address - Country:US
Mailing Address - Phone:615-331-6200
Mailing Address - Fax:
Practice Address - Street 1:31B BOWLING DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6100
Practice Address - Country:US
Practice Address - Phone:731-660-6493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000009118251C00000X, 253Z00000X, 320900000X
TNPSS0000000278251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE02Medicaid