Provider Demographics
NPI:1609827468
Name:TNMO HEALTHCARE, LLC
Entity Type:Organization
Organization Name:TNMO HEALTHCARE, LLC
Other - Org Name:GENTIVA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF LICENSURE
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-662-1761
Mailing Address - Street 1:PO BOX 4060
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4060
Mailing Address - Country:US
Mailing Address - Phone:704-664-2876
Mailing Address - Fax:
Practice Address - Street 1:2024 S MAIDEN LN STE 202
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0319
Practice Address - Country:US
Practice Address - Phone:417-782-6811
Practice Address - Fax:417-782-6854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TNMO HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104-8HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1609827468Medicaid
MO1609827468Medicaid