Provider Demographics
NPI:1811952062
Name:J.W. CARELL ENTERPRISES, LLC
Entity type:Organization
Organization Name:J.W. CARELL ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-781-0666
Mailing Address - Street 1:200 HOBSON ST
Mailing Address - Street 2:STE 44
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1671
Mailing Address - Country:US
Mailing Address - Phone:931-473-9556
Mailing Address - Fax:931-474-1910
Practice Address - Street 1:200 HOBSON ST
Practice Address - Street 2:STE 44
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1671
Practice Address - Country:US
Practice Address - Phone:931-473-9556
Practice Address - Fax:931-474-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000265251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
A3711001OtherAMERICHOICE PROVIDER ID
TN01-035023OtherAMERIGROUP COMMUNITY CARIE PROVIDER ID
TN4167951OtherBC/BS PROVIDER ID
TN447316Medicare ID - Type UnspecifiedPROVIDER NUMBER MCMINNVIL