Provider Demographics
NPI:1437867108
Name:HEMPHILL SUPPORTIVE LIVING
Entity Type:Organization
Organization Name:HEMPHILL SUPPORTIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMPHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-432-7908
Mailing Address - Street 1:201 EADS ST APT 133
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-4082
Mailing Address - Country:US
Mailing Address - Phone:423-432-7908
Mailing Address - Fax:
Practice Address - Street 1:102 JORDAN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6731
Practice Address - Country:US
Practice Address - Phone:423-432-7908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ072620Medicaid