Provider Demographics
NPI:1881028298
Name:AVE MARIA REGINA HEALTH SYSTEMS
Entity Type:Organization
Organization Name:AVE MARIA REGINA HEALTH SYSTEMS
Other - Org Name:AVE MARIA REGINA HOME HEALTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROJECT MANAGER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IFEYINWA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHOLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-530-8111
Mailing Address - Street 1:4008 PEPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1667
Mailing Address - Country:US
Mailing Address - Phone:615-530-8111
Mailing Address - Fax:615-280-2538
Practice Address - Street 1:4008 PEPPERWOOD DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1667
Practice Address - Country:US
Practice Address - Phone:615-530-8111
Practice Address - Fax:615-280-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000012695251C00000X, 251E00000X, 253Z00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445771Medicaid
TNT000431Medicaid