Provider Demographics
NPI:1295169910
Name:@ HOME OF CENTRAL TENNESSEE
Entity type:Organization
Organization Name:@ HOME OF CENTRAL TENNESSEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-891-4792
Mailing Address - Street 1:5205 MARYLAND WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-891-4792
Mailing Address - Fax:615-891-4831
Practice Address - Street 1:5205 MARYLAND WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1006
Practice Address - Country:US
Practice Address - Phone:615-891-4792
Practice Address - Fax:615-891-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000009175253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care