Provider Demographics
NPI:1912119199
Name:CAPABILITIES FOR LIVING, LLC
Entity Type:Organization
Organization Name:CAPABILITIES FOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:BS,IT
Authorized Official - Phone:901-507-4780
Mailing Address - Street 1:748 WALNUT KNOLL LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3110
Mailing Address - Country:US
Mailing Address - Phone:901-507-4780
Mailing Address - Fax:901-507-4786
Practice Address - Street 1:748 WALNUT KNOLL LN
Practice Address - Street 2:SUITE 1
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3110
Practice Address - Country:US
Practice Address - Phone:901-507-4780
Practice Address - Fax:901-507-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000000002261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36555Medicaid
TN4075307OtherBCBS CLINIC ID
TN4075308OtherSANDY FLETCHALL BCBS ID