Healthcare Provider Details

I. General information

NPI: 1720242233
Provider Name (Legal Business Name): RHA TN GROUP HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
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

1802 PENNINGTON DR
MURFREESBORO TN
37129-0803
US

V. Phone/Fax

Practice location:
  • Phone: 615-895-7788
  • Fax:
Mailing address:
  • Phone: 615-890-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberL323-117-4116
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberL323-117-4116
License Number StateTN

VIII. Authorized Official

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