Provider Demographics
NPI:1578938130
Name:DEBRAS HOUSE OF CARE
Entity Type:Organization
Organization Name:DEBRAS HOUSE OF CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:NESBIT
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS MANAGEMENT
Authorized Official - Phone:901-949-1593
Mailing Address - Street 1:3522 THISTLE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-9476
Mailing Address - Country:US
Mailing Address - Phone:901-949-1593
Mailing Address - Fax:
Practice Address - Street 1:3522 THISTLE VALLEY LN
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-9476
Practice Address - Country:US
Practice Address - Phone:901-949-1593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000000017287253Z00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========Medicaid
TN=========Medicare UPIN