Provider Demographics
NPI:1588045199
Name:MIDDLE TENNESSEE HOMES
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE HOMES
Other - Org Name:WILFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:MIDDLE TENNESSEE HOMES DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMA
Authorized Official - Middle Name:MCCROSKEY
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:615-231-5373
Mailing Address - Street 1:400 DEADRICK STREET
Mailing Address - Street 2:CITIZENS PLAZA SUITE 900
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37243
Mailing Address - Country:US
Mailing Address - Phone:615-231-5373
Mailing Address - Fax:615-231-5074
Practice Address - Street 1:2410 WILFORD DRIVE
Practice Address - Street 2:
Practice Address - City:DONELSON
Practice Address - State:TN
Practice Address - Zip Code:37214
Practice Address - Country:US
Practice Address - Phone:615-231-5373
Practice Address - Fax:615-231-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7447188Medicaid
TN7447184Medicaid
TN7447185Medicaid
TN7447187Medicaid
TN7447010Medicaid
TN7447186Medicaid