Provider Demographics
NPI:1447588579
Name:STAFFCO OF EASTERN TENNESSEE, LLC.
Entity Type:Organization
Organization Name:STAFFCO OF EASTERN TENNESSEE, LLC.
Other - Org Name:AT HOME HEALTHCARE OF EAST TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:NIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:423-473-9922
Mailing Address - Street 1:2654 PEERLESS RD NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3732
Mailing Address - Country:US
Mailing Address - Phone:423-473-9922
Mailing Address - Fax:423-473-9924
Practice Address - Street 1:2654 PEERLESS RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3732
Practice Address - Country:US
Practice Address - Phone:423-473-9922
Practice Address - Fax:423-473-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000005138251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445298Medicaid
TN000000005138OtherSTATE OF TENNESSEE DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES