Provider Demographics
NPI:1225251150
Name:NORTHWEST TENNESSEE HUMAN RESOURCE AGENCY
Entity Type:Organization
Organization Name:NORTHWEST TENNESSEE HUMAN RESOURCE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-587-4213
Mailing Address - Street 1:124 WELDON DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-1308
Mailing Address - Country:US
Mailing Address - Phone:731-587-4213
Mailing Address - Fax:731-587-4587
Practice Address - Street 1:124 WELDON DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-1308
Practice Address - Country:US
Practice Address - Phone:731-587-4213
Practice Address - Fax:731-587-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered332U00000XSuppliersHome Delivered Meals
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Not Answered374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445798Medicaid