Provider Demographics
NPI:1407845944
Name:HOME HEALTH CARE OF WEST TENNESSEE, INC.
Entity Type:Organization
Organization Name:HOME HEALTH CARE OF WEST TENNESSEE, INC.
Other - Org Name:ADORATION HOME HEALTH CARE WEST TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-2321
Mailing Address - Street 1:2995 APPLING RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8963
Mailing Address - Country:US
Mailing Address - Phone:901-266-5100
Mailing Address - Fax:
Practice Address - Street 1:2995 APPLING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-8963
Practice Address - Country:US
Practice Address - Phone:901-266-5100
Practice Address - Fax:901-266-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN227251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4060536OtherBCBSTN PROVIDER NUMBER
TN44Q7564001OtherMEDICARE BRANCH ID (ATOKA)
TN447564OtherAETNA PROVIDER NUMBER
TN0447564Medicaid
TN447564OtherTRI CARE PROVIDER NUMBER
TN44Q7564001OtherMEDICARE BRANCH ID (ATOKA)