Healthcare Provider Details

I. General information

NPI: 1154600807
Provider Name (Legal Business Name): PAULINE & THOMAS HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 ALMAVILLE RD
SMYRNA TN
37167-5784
US

IV. Provider business mailing address

1943 ALMAVILLE RD
SMYRNA TN
37167-5784
US

V. Phone/Fax

Practice location:
  • Phone: 615-896-8231
  • Fax: 615-462-7101
Mailing address:
  • Phone: 615-896-8231
  • Fax: 615-462-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberL00000000774
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberL000000007744
License Number StateTN

VIII. Authorized Official

Name: MR. THOMAS MMBAGA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 615-896-8231