Provider Demographics
NPI:1790093946
Name:AT HOME HEALTHCARE OF NORTHEASTERN TENNESSEE
Entity Type:Organization
Organization Name:AT HOME HEALTHCARE OF NORTHEASTERN TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-247-5645
Mailing Address - Street 1:301 S GALLAHER VIEW RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5355
Mailing Address - Country:US
Mailing Address - Phone:865-247-5645
Mailing Address - Fax:865-247-5670
Practice Address - Street 1:301 S GALLAHER VIEW RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5355
Practice Address - Country:US
Practice Address - Phone:865-247-5645
Practice Address - Fax:865-247-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health