Healthcare Provider Details

I. General information

NPI: 1558270157
Provider Name (Legal Business Name):
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 HAMILTON LN
ANTIOCH TN
37013-5486
US

IV. Provider business mailing address

4541 HAMILTON LN
ANTIOCH TN
37013-5486
US

V. Phone/Fax

Practice location:
  • Phone: 615-606-5246
  • Fax:
Mailing address:
  • Phone: 615-606-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: FRASHETA STUART
Title or Position: MANAGING MEMBER
Credential: LPN
Phone: 615-606-5246