Healthcare Provider Details

I. General information

NPI: 1720502479
Provider Name (Legal Business Name): SC HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 PURPLE LEAF LN
CORDOVA TN
38016-5365
US

IV. Provider business mailing address

2149 PURPLE LEAF LN
CORDOVA TN
38016-5365
US

V. Phone/Fax

Practice location:
  • Phone: 901-871-9270
  • Fax: 901-320-3703
Mailing address:
  • Phone: 901-871-9270
  • Fax: 901-320-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number170004393
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. ERICA Q COOPER
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: MBA, MAED, APM
Phone: 901-871-9270