Provider Demographics
NPI:1013562529
Name:SOUTH CENTRAL HUMAN RESOURCE AGENCY
Entity Type:Organization
Organization Name:SOUTH CENTRAL HUMAN RESOURCE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-433-7182
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-0638
Mailing Address - Country:US
Mailing Address - Phone:931-433-7182
Mailing Address - Fax:931-438-0074
Practice Address - Street 1:1437 WINCHESTER HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2757
Practice Address - Country:US
Practice Address - Phone:931-433-7182
Practice Address - Fax:931-438-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445781Medicaid