Healthcare Provider Details

I. General information

NPI: 1649765553
Provider Name (Legal Business Name): TUCKER'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BEASLEY DRIVE UNIT G
FRANKLIN TN
37064
US

IV. Provider business mailing address

PO BOX 968
SPRING HILL TN
37174
US

V. Phone/Fax

Practice location:
  • Phone: 615-310-5224
  • Fax: 615-777-3173
Mailing address:
  • Phone: 615-310-5224
  • Fax: 615-777-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: SUNNY ROSANBALM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 615-504-3185