Provider Demographics
NPI:1124356258
Name:TENNESSEE COMMUNITY SERVICES AGENCY
Entity Type:Organization
Organization Name:TENNESSEE COMMUNITY SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCWHERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-884-2630
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:1604 WEST REELFOOT AVENUE
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38281-0368
Mailing Address - Country:US
Mailing Address - Phone:731-884-2640
Mailing Address - Fax:731-884-2644
Practice Address - Street 1:6 STONEBRIDGE BLVD
Practice Address - Street 2:STE G
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2166
Practice Address - Country:US
Practice Address - Phone:731-984-9030
Practice Address - Fax:731-664-4623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10000000004532253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445-085Medicaid