Provider Demographics
NPI:1801819784
Name:BUCKEYE HOME HEALTH CENTER
Entity Type:Organization
Organization Name:BUCKEYE HOME HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:931-879-9926
Mailing Address - Street 1:PO BOX 1197
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556
Mailing Address - Country:US
Mailing Address - Phone:931-879-9926
Mailing Address - Fax:931-752-7849
Practice Address - Street 1:1125 GROVE ST
Practice Address - Street 2:SUITE 130
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1512
Practice Address - Country:US
Practice Address - Phone:865-458-8905
Practice Address - Fax:865-458-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN508332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454487Medicaid
TN1454487Medicaid