Provider Demographics
NPI:1720105851
Name:SCOTT APPALACHIAN INDUSTRIES, INC.
Entity Type:Organization
Organization Name:SCOTT APPALACHIAN INDUSTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS DEGREE
Authorized Official - Phone:423-663-3818
Mailing Address - Street 1:591 E MONTICELLO PIKE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756-4109
Mailing Address - Country:US
Mailing Address - Phone:423-663-9300
Mailing Address - Fax:423-663-3365
Practice Address - Street 1:591 E MONTICELLO PIKE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-4109
Practice Address - Country:US
Practice Address - Phone:423-663-3818
Practice Address - Fax:423-663-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL 3(20)4M5-066-1387251C00000X
TNPSS0000000124314000000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0522OtherDMRS PROVIDER #