Provider Demographics
NPI:1619408143
Name:HOME CAREGIVERS OF COOKEVILLE
Entity Type:Organization
Organization Name:HOME CAREGIVERS OF COOKEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEPIFANTSEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-528-8585
Mailing Address - Street 1:118 S DIXIE AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3405
Mailing Address - Country:US
Mailing Address - Phone:931-528-8585
Mailing Address - Fax:
Practice Address - Street 1:118 S DIXIE AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3405
Practice Address - Country:US
Practice Address - Phone:931-528-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL4380963546251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445769OtherTENNCARE