Healthcare Provider Details

I. General information

NPI: 1881028298
Provider Name (Legal Business Name): AVE MARIA REGINA HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 PEPPERWOOD DR
ANTIOCH TN
37013-1667
US

IV. Provider business mailing address

4008 PEPPERWOOD DR
ANTIOCH TN
37013-1667
US

V. Phone/Fax

Practice location:
  • Phone: 615-530-8111
  • Fax: 615-280-2538
Mailing address:
  • Phone: 615-530-8111
  • Fax: 615-280-2538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1000000012695
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1000000012695
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1000000012695
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number1000000012695
License Number StateTN

VIII. Authorized Official

Name: IFEYINWA AGHOLOR
Title or Position: PROJECT MANAGER / PRESIDENT
Credential:
Phone: 615-530-8111