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General NPI Number Information
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NPI Number | 1316222375
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Entity Type | Organization
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Legal Business Name | RETIRE AT HOME SENIOR CARE LLC
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 501 MOSE DR
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City | SPARTA
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State | TN
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Zip | 38583-1212
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Country | US
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Telephone | 615-567-5852
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Fax | 866-704-5370
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Provider Business Mailing Address
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Address Line | 501 MOSE DR
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City | SPARTA
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State | TN
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Zip | 38583-1212
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Country | US
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Telephone | 615-567-5852
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Fax | 866-704-5370
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TAHIR RAJAB
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Credential | RN
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Telephone | 256-499-0984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | L000000009368
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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