Healthcare Provider Details

I. General information

NPI: 1225038011
Provider Name (Legal Business Name): RHA TENNESSEE GROUP HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 MEMORIAL BLVD
MURFREESBORO TN
37129-0208
US

IV. Provider business mailing address

3606 SULPHUR SPRINGS RD
MURFREESBORO TN
37129-5884
US

V. Phone/Fax

Practice location:
  • Phone: 615-895-7788
  • Fax: 615-895-6999
Mailing address:
  • Phone: 615-849-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberL323-117-4122
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberL 320-015-600
License Number StateTN

VIII. Authorized Official

Name: MRS. LISA ANN IZZI
Title or Position: ADMINISTRATOR
Credential:
Phone: 615-895-7788