Provider Demographics
NPI:1346656402
Name:IN-HOME CARE OF COOKEVILLE, LLC
Entity Type:Organization
Organization Name:IN-HOME CARE OF COOKEVILLE, LLC
Other - Org Name:A BETTER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-303-0411
Mailing Address - Street 1:605 N WILLOW AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1717
Mailing Address - Country:US
Mailing Address - Phone:931-303-0411
Mailing Address - Fax:
Practice Address - Street 1:605 N WILLOW AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1717
Practice Address - Country:US
Practice Address - Phone:931-303-0411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000000015022OtherSTATE OF TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
TNH445832Medicaid