Provider Demographics
NPI:1275846404
Name:STAFFCO OF EASTERN TN. INC
Entity Type:Organization
Organization Name:STAFFCO OF EASTERN TN. INC
Other - Org Name:AT HOME HEALTH CARE OF CENTRAL TN.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PERSONNEL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-954-0550
Mailing Address - Street 1:102 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1525
Mailing Address - Country:US
Mailing Address - Phone:931-954-0550
Mailing Address - Fax:931-954-0552
Practice Address - Street 1:102 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1525
Practice Address - Country:US
Practice Address - Phone:931-954-0550
Practice Address - Fax:931-954-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251J00000X
TN1000000005558253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care