Healthcare Provider Details

I. General information

NPI: 1437867108
Provider Name (Legal Business Name): HEMPHILL SUPPORTIVE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 JORDAN DR
CHATTANOOGA TN
37421-6731
US

IV. Provider business mailing address

201 EADS ST APT 133
CHATTANOOGA TN
37412-4082
US

V. Phone/Fax

Practice location:
  • Phone: 423-432-7908
  • Fax:
Mailing address:
  • Phone: 423-432-7908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: RASHUNDA HEMPHILL
Title or Position: OWNER
Credential:
Phone: 423-432-7908