Provider Demographics
NPI:1912160078
Name:ST BARNABAS APARTMENTS ASSISTED LIVING INC
Entity Type:Organization
Organization Name:ST BARNABAS APARTMENTS ASSISTED LIVING INC
Other - Org Name:ST BARNABAS SENIOR LIVING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWNBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-847-4124
Mailing Address - Street 1:300 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1111
Mailing Address - Country:US
Mailing Address - Phone:423-847-4600
Mailing Address - Fax:423-847-4139
Practice Address - Street 1:950 SISKIN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1309
Practice Address - Country:US
Practice Address - Phone:423-847-4124
Practice Address - Fax:423-847-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000134310400000X
311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445187Medicaid