Healthcare Provider Details

I. General information

NPI: 1649771098
Provider Name (Legal Business Name): SPECTRUM HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 DEBRA DR
ANTIOCH TN
37013-2904
US

IV. Provider business mailing address

4717 DEBRA DR
ANTIOCH TN
37013-2904
US

V. Phone/Fax

Practice location:
  • Phone: 615-928-0192
  • Fax:
Mailing address:
  • Phone: 615-928-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. ERICA MCWILLIAMS
Title or Position: DIRECTOR
Credential: OWNER
Phone: 615-928-0192