Provider Demographics
NPI:1427418862
Name:ANTIOCH HEALTH CARE CORP
Entity Type:Organization
Organization Name:ANTIOCH HEALTH CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:KEYENASOA
Authorized Official - Last Name:EKUNDAYO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:615-887-0309
Mailing Address - Street 1:522 BELL RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2002
Mailing Address - Country:US
Mailing Address - Phone:615-788-1047
Mailing Address - Fax:
Practice Address - Street 1:522 BELL RD
Practice Address - Street 2:UNIT C
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2002
Practice Address - Country:US
Practice Address - Phone:615-788-1047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN645163305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization