Healthcare Provider Details

I. General information

NPI: 1821922899
Provider Name (Legal Business Name): MOMBA HOME CARE TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W END AVE STE 500
NASHVILLE TN
37203-1322
US

IV. Provider business mailing address

400 PERIMETER CENTER TER NE STE 300
ATLANTA GA
30346-1201
US

V. Phone/Fax

Practice location:
  • Phone: 615-864-0684
  • Fax:
Mailing address:
  • Phone: 615-864-0684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELAZAR HUISMAN
Title or Position: OPERATIONS
Credential:
Phone: 404-418-7484