Healthcare Provider Details

I. General information

NPI: 1760844559
Provider Name (Legal Business Name): HELEN R TUCKER ADULT DEVELOPMENT CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 HIGHWAY 51 N
RIPLEY TN
38063-8114
US

IV. Provider business mailing address

PO BOX 648
RIPLEY TN
38063-0648
US

V. Phone/Fax

Practice location:
  • Phone: 731-635-4290
  • Fax: 731-635-8975
Mailing address:
  • Phone: 731-635-4290
  • Fax: 731-635-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberL000000014226
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberL000000014226
License Number StateTN

VIII. Authorized Official

Name: SUZANNE ELIZABETH WIEBER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 731-635-4290