Davis Supportive Living Home Inc.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

0000000291 Issued in TN

Legal business name

DAVIS SUPPORTIVE LIVING HOME INC.

Practice address

1106 Duncan Avenue
Chattanooga, TN 37404

Phone

(423) 825-5210

Fax

(423) 821-5071

NPI assigned

Dec 14, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lubron Davis

Title

Administrator

Phone

(423) 825-5210

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513209600000",
    "number": "1245746171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4627 KIRKLAND AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37410",
            "telephone_number": "423-825-5210",
            "fax_number": "423-821-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 DUNCAN AVENUE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37404",
            "telephone_number": "423-825-5210",
            "fax_number": "423-821-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS SUPPORTIVE LIVING HOME INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-14",
        "last_updated": "2017-12-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LUBRON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "423-825-5210"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "TN",
            "license": "0000000291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Millison Lane David, OD
• Joy David, RBT
• Stephanie Nicole David, M.D.
• Ryann Davidson, RN
• Victoria J Davidson, LCSW
• Sabrina Davis-
• Adolfo James Davis, DNP, AGACNP-BC
• Allan Eric Davis, MD
• Allison Davis
• Anna Meredith Davis

• Adult Care Home Facility in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Adult Care Home Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.