Healthcare Provider Details

I. General information

NPI: 1922349430
Provider Name (Legal Business Name): MED ARC HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 LERA JONES DR
ANTIOCH TN
37013-1317
US

IV. Provider business mailing address

2888 LERA JONES DR
ANTIOCH TN
37013-1317
US

V. Phone/Fax

Practice location:
  • Phone: 615-712-9626
  • Fax:
Mailing address:
  • Phone: 615-712-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: CHRIS SIMMONS
Title or Position: AGENT
Credential: COTA/L
Phone: 615-712-9626