Provider Demographics
NPI:1851039978
Name:MGA HOME HEALTHCARE TENNESSEE, LLC
Entity Type:Organization
Organization Name:MGA HOME HEALTHCARE TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KOLOSKUS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:720-276-7706
Mailing Address - Street 1:7025 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1661 INTERNATIONAL DR STE 400
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1431
Practice Address - Country:US
Practice Address - Phone:901-221-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health