Healthcare Provider Details

I. General information

NPI: 1114309614
Provider Name (Legal Business Name): TRI-STATE COMMUNITY HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8841 KENBROOK CV
CORDOVA TN
38018-7657
US

IV. Provider business mailing address

8841 KENBROOK CV
CORDOVA TN
38018-7657
US

V. Phone/Fax

Practice location:
  • Phone: 215-760-4835
  • Fax:
Mailing address:
  • Phone: 215-760-4835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY PAULA MCKAY
Title or Position: OWNER
Credential: RN MSN
Phone: 215-760-4835