Provider Demographics
NPI:1346724143
Name:TK HOME KARING SERVICE
Entity Type:Organization
Organization Name:TK HOME KARING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CNA
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZELRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-432-9401
Mailing Address - Street 1:PO BOX 80232
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-7232
Mailing Address - Country:US
Mailing Address - Phone:440-895-7316
Mailing Address - Fax:
Practice Address - Street 1:209 CROLL CT APT 125
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37410-1017
Practice Address - Country:US
Practice Address - Phone:423-432-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health