Provider Demographics
NPI:1851323562
Name:STILL WATERS HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:STILL WATERS HOME HEALTH AGENCY LLC
Other - Org Name:LENORA R. HERRING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-493-9476
Mailing Address - Street 1:856 WILLOW TREE CIR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6376
Mailing Address - Country:US
Mailing Address - Phone:901-493-9476
Mailing Address - Fax:901-794-7877
Practice Address - Street 1:856 WILLOW TREE CIR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6376
Practice Address - Country:US
Practice Address - Phone:901-493-9476
Practice Address - Fax:901-794-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN447570Medicare Oscar/Certification
TN44-7570Medicare PIN