Provider Demographics
NPI:1376772046
Name:HOME SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:HOME SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIONE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:865-525-9626
Mailing Address - Street 1:2723 E MAGNOLIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-5247
Mailing Address - Country:US
Mailing Address - Phone:865-525-9626
Mailing Address - Fax:888-678-4908
Practice Address - Street 1:2723 E MAGNOLIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-5247
Practice Address - Country:US
Practice Address - Phone:865-525-9626
Practice Address - Fax:888-678-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI000000004758253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445299Medicaid