Provider Demographics
NPI:1235293655
Name:VANDERBILT HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:VANDERBILT HOME CARE SERVICES, LLC
Other - Org Name:VANDERBILT HOME CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-936-0390
Mailing Address - Street 1:2120 BELCOURT AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-936-0336
Mailing Address - Fax:615-936-0352
Practice Address - Street 1:2120 BELCOURT AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-936-0336
Practice Address - Fax:615-936-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000065251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTNH184OtherOASIS IDENTIFIER
TN00000065OtherFACILITY LICENSE NUMBER
TNTNH184OtherOASIS IDENTIFIER