1255712832 NPI number — MIDDLE TENNESSEE HOMES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255712832 NPI number — MIDDLE TENNESSEE HOMES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLE TENNESSEE HOMES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255712832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 DEADRICK STREET
Provider Second Line Business Mailing Address:
CITIZENS PLAZA SUITE 900
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-231-5373
Provider Business Mailing Address Fax Number:
615-231-5074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4937 SAUNDERSVILLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD HICKORY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-231-5373
Provider Business Practice Location Address Fax Number:
615-231-5074
Provider Enumeration Date:
06/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
JAMA
Authorized Official Middle Name:
MCCROSKEY
Authorized Official Title or Position:
MIDDLE TENNESSEE HOMES DIRECTOR
Authorized Official Telephone Number:
615-231-5373

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7447185 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447186 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447187 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447010 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447184 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447188 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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