Provider Demographics
NPI:1346705704
Name:CLINCH RIVER HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:CLINCH RIVER HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIE EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUMWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-669-4260
Mailing Address - Street 1:614 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4459
Mailing Address - Country:US
Mailing Address - Phone:307-856-2600
Mailing Address - Fax:
Practice Address - Street 1:111 EXECUTIVE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-2222
Practice Address - Country:US
Practice Address - Phone:865-457-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-09
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA