1689804700 NPI number — KNOXVILLE HOME THERAPIES LLC

Table of content: (NPI 1689804700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689804700 NPI number — KNOXVILLE HOME THERAPIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNOXVILLE HOME THERAPIES 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:
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:
1689804700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4222 PAYSPHERE CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-0042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-879-6137
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 HENSON RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37921-5346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-602-7887
Provider Business Practice Location Address Fax Number:
865-602-4202
Provider Enumeration Date:
07/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CFO
Authorized Official Telephone Number:
800-879-6137

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  1955 , 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)

  • Identifier: 1452160 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1955 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4430497 . This is a "NCPDP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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