Healthcare Provider Details

I. General information

NPI: 1780058511
Provider Name (Legal Business Name): FON TRANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HARBOR OAKS CV
OAKLAND TN
38060-6069
US

IV. Provider business mailing address

50 HARBOR OAKS CV
OAKLAND TN
38060-6069
US

V. Phone/Fax

Practice location:
  • Phone: 901-355-4258
  • Fax:
Mailing address:
  • Phone: 901-355-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. FONDA L MOODY
Title or Position: OWNER
Credential:
Phone: 901-355-4258