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General NPI Number Information
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NPI Number | 1447664008
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Entity Type | Organization
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Legal Business Name | FULLER HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 7404 TARMAC WAY
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City | NASHVILLE
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State | TN
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Zip | 37211-0209
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Country | US
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Telephone | 615-916-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 7404 TARMAC WAY
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City | NASHVILLE
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State | TN
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Zip | 37211-0209
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Country | US
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Telephone | 615-916-1233
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REVETA OLIVIA FULLER
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Credential |
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Telephone | 615-916-1233
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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 | 1000000014510
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License Number State | TN
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