Provider Demographics
NPI:1447527643
Name:BUBBA'S BETTER LIFE, INC.
Entity type:Organization
Organization Name:BUBBA'S BETTER LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-925-4905
Mailing Address - Street 1:265 CENTERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-7215
Mailing Address - Country:US
Mailing Address - Phone:731-925-4905
Mailing Address - Fax:731-925-4906
Practice Address - Street 1:265 CENTERVIEW RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-7215
Practice Address - Country:US
Practice Address - Phone:731-925-4905
Practice Address - Fax:731-925-4906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF56Medicaid