Provider Demographics
NPI:1780935312
Name:SCHOLAR CARE COLLABORATIVE GROUP, INC
Entity type:Organization
Organization Name:SCHOLAR CARE COLLABORATIVE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TISDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:901-598-7292
Mailing Address - Street 1:5170 HICKORY HOLLOW PKWY UNIT 407
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3089
Mailing Address - Country:US
Mailing Address - Phone:615-573-2412
Mailing Address - Fax:
Practice Address - Street 1:5170 HICKORY HOLLOW PKWY UNIT 407
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3089
Practice Address - Country:US
Practice Address - Phone:615-573-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3140N1450X, 320800000X
TN320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness