Provider Demographics
NPI:1851859441
Name:AIDESIDE HOME HEALTHCARE
Entity Type:Organization
Organization Name:AIDESIDE HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEELIN
Authorized Official - Middle Name:JAFARI
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-419-0047
Mailing Address - Street 1:705 GATE LN STE 202
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3521
Mailing Address - Country:US
Mailing Address - Phone:865-419-0047
Mailing Address - Fax:865-315-7021
Practice Address - Street 1:705 GATE LN STE 202
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3521
Practice Address - Country:US
Practice Address - Phone:865-294-0059
Practice Address - Fax:865-315-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1851859441OtherSUPPORTIVE SERVICES