1477564375 NPI number — HOME THERAPY INC.

Table of content: (NPI 1477564375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477564375 NPI number — HOME THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME THERAPY INC.
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:
ACTIVE MEDICAL & MOBILITY
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:
1477564375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADAMSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38310-4961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-632-9820
Provider Business Mailing Address Fax Number:
866-430-7946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADAMSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38310-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-632-9820
Provider Business Practice Location Address Fax Number:
866-430-7946
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCKNER
Authorized Official First Name:
LORRAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
731-632-9820

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000939 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: 0000000939 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 0000000939 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00040342 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100230069 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4581588 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000011213 . This is a "BCBS, PPO" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 0132771 . This is a "BCBS, HIT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00330076 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172669 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000011210 . This is a "BCBS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 310-5120 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9250047 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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