Provider Demographics
NPI:1184949059
Name:SUNCREST HOME HEALTH OF NASHVILLE, INC.
Entity type:Organization
Organization Name:SUNCREST HOME HEALTH OF NASHVILLE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PROFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:510 HOSPITAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5033
Mailing Address - Country:US
Mailing Address - Phone:615-627-9267
Mailing Address - Fax:615-577-0081
Practice Address - Street 1:2292 DALTON DR STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8961
Practice Address - Country:US
Practice Address - Phone:931-552-1674
Practice Address - Fax:931-552-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TN293251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0447259Medicaid
TN0447259Medicaid