Provider Demographics
NPI:1013450964
Name:THE MCLEOD HOME INC.
Entity Type:Organization
Organization Name:THE MCLEOD HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:423-400-0107
Mailing Address - Street 1:4704 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3805
Mailing Address - Country:US
Mailing Address - Phone:423-505-7866
Mailing Address - Fax:
Practice Address - Street 1:4704 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3805
Practice Address - Country:US
Practice Address - Phone:423-505-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-27
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness