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General NPI Number Information
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NPI Number | 1346705704
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Entity Type | Organization
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Legal Business Name | CLINCH RIVER HOME HEALTHCARE, INC.
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Dates
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Enumeration Date | 02/09/2019
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 111 EXECUTIVE PARK DRIVE
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City | CLINTON
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State | TN
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Zip | 37716-2222
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Country | US
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Telephone | 865-457-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 614 E MAIN ST
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City | RIVERTON
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State | WY
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Zip | 82501-4459
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Country | US
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Telephone | 307-856-2600
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Fax |
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Authorized Official
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Title or Position | CHIE EXECUTIVE OFFICER
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Name | CHAD SHUMWAY
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Credential |
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Telephone | 801-669-4260
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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 |
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License Number State |
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