Provider Demographics
NPI:1992177638
Name:WEST TENNESSEE COMMUNITY HOMES
Entity Type:Organization
Organization Name:WEST TENNESSEE COMMUNITY HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, WEST TENNESSEE HOMES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-745-7193
Mailing Address - Street 1:P.O. BOX 949
Mailing Address - Street 2:11437 MILTON WILSON ROAD
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002
Mailing Address - Country:US
Mailing Address - Phone:901-745-7193
Mailing Address - Fax:901-745-7379
Practice Address - Street 1:5982 POLK STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002
Practice Address - Country:US
Practice Address - Phone:901-867-9614
Practice Address - Fax:901-290-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000013847315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities