1821629031 NPI number — BUCKEYE HOME HEALTH CENTER, INC.

Table of content: (NPI 1821629031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821629031 NPI number — BUCKEYE HOME HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUCKEYE HOME HEALTH CENTER, 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:
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:
1821629031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1197
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38556-1197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-752-7123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
689 MEDICAL PARK DR STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37772-5797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-317-1511
Provider Business Practice Location Address Fax Number:
865-317-1577
Provider Enumeration Date:
01/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
RAMSEY
Authorized Official First Name:
LISA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
931-752-7123

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q057724 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 508 . This is a "DEPARTMENT OF HEALTH LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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