MEDICARE: CLINCH RIVER HOME HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1346705704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINCH RIVER HOME HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	614 E MAIN ST
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-4459
Country	:	US
Telephone Number	:	307-856-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 EXECUTIVE PARK DRIVE
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-2222
Country	:	US
Telephone Number	:	865-457-4263
Fax Number	:

Authorized Official
Title or Position	:	CHIE EXECUTIVE OFFICER
Name	:	CHAD SHUMWAY
Credential	:
Telephone Number	:	801-669-4260

Provider Enumeration Date	:	02/09/2019
Last Update Date	:	06/26/2023

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