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General NPI Number Information
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NPI Number | 1619408143
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Entity Type | Organization
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Legal Business Name | HOME CAREGIVERS OF COOKEVILLE
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 03/26/2017
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Provider Practice Location Address
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Address Line | 118 S DIXIE AVE SUITE 24
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City | COOKEVILLE
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State | TN
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Zip | 38501-3405
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Country | US
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Telephone | 931-528-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 118 S DIXIE AVE SUITE 24
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City | COOKEVILLE
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State | TN
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Zip | 38501-3405
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Country | US
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Telephone | 931-528-8585
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KONSTANTIN YEPIFANTSEV
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Credential |
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Telephone | 931-528-8585
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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 | L4380963546
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License Number State | TN
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