1306216411 NPI number — RHA HEALTH SERVICES TN, LLC

Table of content: (NPI 1306216411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306216411 NPI number — RHA HEALTH SERVICES TN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHA HEALTH SERVICES TN, LLC
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:
1132 HIGH
Provider Other Organization Name Type Code:
3
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:
1306216411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 US HIGHWAY 45 BYP S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38382-3501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-855-0537
Provider Business Mailing Address Fax Number:
731-855-1257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1132 S HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38382-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-855-0537
Provider Business Practice Location Address Fax Number:
731-855-1257
Provider Enumeration Date:
10/01/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ADDISON
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
901-692-5555

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  L000000012733 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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