Provider Demographics
NPI:1316222375
Name:RETIRE AT HOME SENIOR CARE LLC
Entity Type:Organization
Organization Name:RETIRE AT HOME SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:256-499-0984
Mailing Address - Street 1:501 MOSE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1212
Mailing Address - Country:US
Mailing Address - Phone:615-567-5852
Mailing Address - Fax:866-704-5370
Practice Address - Street 1:501 MOSE DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1212
Practice Address - Country:US
Practice Address - Phone:615-567-5852
Practice Address - Fax:866-704-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000009368251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445263Medicaid