Provider Demographics
NPI:1225119860
Name:NORTHCREST HOME HEALTH
Entity Type:Organization
Organization Name:NORTHCREST HOME HEALTH
Other - Org Name:JESSE HOLMAN JONES HOME HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-384-2411
Mailing Address - Street 1:3251 TOM AUSTIN HWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-4525
Mailing Address - Country:US
Mailing Address - Phone:615-382-3830
Mailing Address - Fax:615-384-5102
Practice Address - Street 1:3251 TOM AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-4525
Practice Address - Country:US
Practice Address - Phone:615-382-3830
Practice Address - Fax:615-384-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000203251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44-7466Medicare ID - Type UnspecifiedPROVIDER NUMBER