Provider Demographics
NPI:1255813705
Name:SPECTRUM HOME HEALTH CARE
Entity type:Organization
Organization Name:SPECTRUM HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-928-0192
Mailing Address - Street 1:4717 DEBRA DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2904
Mailing Address - Country:US
Mailing Address - Phone:615-928-0192
Mailing Address - Fax:
Practice Address - Street 1:4717 DEBRA DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2904
Practice Address - Country:US
Practice Address - Phone:615-928-0192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPLETE REVENUE CYCLE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000895464785Medicaid