Provider Demographics
NPI:1053313874
Name:HOSPICE OF CHATTANOOGA HOLDINGS, LLC
Entity type:Organization
Organization Name:HOSPICE OF CHATTANOOGA HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-331-6271
Mailing Address - Street 1:1234 CHESTNUT ST STE 114
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1491
Mailing Address - Country:US
Mailing Address - Phone:434-977-9711
Mailing Address - Fax:434-235-4142
Practice Address - Street 1:2030 HAMILTON PLACE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6040
Practice Address - Country:US
Practice Address - Phone:423-892-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000393251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000579268AMedicaid
44-1504OtherMEDICARE CCN
1053313874OtherNATIONAL PROVIDER IDENTIFIER
TN0447283Medicaid