Provider Demographics
NPI:1508007048
Name:HOME CARE MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:HOME CARE MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-543-5652
Mailing Address - Street 1:609 REGENCY LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3062
Mailing Address - Country:US
Mailing Address - Phone:423-543-5652
Mailing Address - Fax:423-543-5651
Practice Address - Street 1:609 REGENCY LN
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3062
Practice Address - Country:US
Practice Address - Phone:423-543-5652
Practice Address - Fax:423-543-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNH445144251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445144Medicaid