Provider Demographics
NPI:1174267686
Name:WCSC TENNESSEE, LLC
Entity Type:Organization
Organization Name:WCSC TENNESSEE, LLC
Other - Org Name:HOME INSTEAD-TN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NOOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-246-6497
Mailing Address - Street 1:PO BOX 28589
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54324-0589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2803A FOSTER AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-5305
Practice Address - Country:US
Practice Address - Phone:615-831-2358
Practice Address - Fax:615-831-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ074147Medicaid