Provider Demographics
NPI:1790236867
Name:TENNESSEE HOME CARE
Entity Type:Organization
Organization Name:TENNESSEE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHESTINE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-679-7636
Mailing Address - Street 1:4527 ABERTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7175
Mailing Address - Country:US
Mailing Address - Phone:901-679-7636
Mailing Address - Fax:
Practice Address - Street 1:4527 ABERTON DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7175
Practice Address - Country:US
Practice Address - Phone:901-679-7636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care