Provider Demographics
NPI:1407891161
Name:MID-CUMBERLAND HUMAN RESOURCE AGENCY
Entity Type:Organization
Organization Name:MID-CUMBERLAND HUMAN RESOURCE AGENCY
Other - Org Name:MID-CUMBERLAND HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-850-3902
Mailing Address - Street 1:1101 KERMIT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2126
Mailing Address - Country:US
Mailing Address - Phone:615-331-6033
Mailing Address - Fax:615-834-8776
Practice Address - Street 1:8 MATHIS DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-7038
Practice Address - Country:US
Practice Address - Phone:615-441-1747
Practice Address - Fax:615-441-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000074251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44-7155Medicare ID - Type Unspecified