Healthcare Provider Details

I. General information

NPI: 1497082101
Provider Name (Legal Business Name): HOMELIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PEBBLE GLEN DR
FRANKLIN TN
37064-2911
US

IV. Provider business mailing address

PO BOX 682713
FRANKLIN TN
37068-2713
US

V. Phone/Fax

Practice location:
  • Phone: 615-604-6873
  • Fax: 615-791-0707
Mailing address:
  • Phone: 615-604-6873
  • Fax: 615-791-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number00061638
License Number StateTN

VIII. Authorized Official

Name: KIRK DICKSON RUTTER
Title or Position: CHIEF MANAGER
Credential:
Phone: 615-604-6873