Provider Demographics
NPI:1164135349
Name:PERSONALIZED CAREGIVING OF TENNESSEE, LLC
Entity Type:Organization
Organization Name:PERSONALIZED CAREGIVING OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-606-1212
Mailing Address - Street 1:9111 CROSS PARK DR STE D200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4521
Mailing Address - Country:US
Mailing Address - Phone:865-606-1212
Mailing Address - Fax:865-409-5791
Practice Address - Street 1:9111 CROSS PARK DR STE D200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4521
Practice Address - Country:US
Practice Address - Phone:865-606-1212
Practice Address - Fax:865-409-5791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care