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General NPI Number Information
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NPI Number | 1851039978
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Entity Type | Organization
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Legal Business Name | MGA HOME HEALTHCARE TENNESSEE, LLC
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 1661 INTERNATIONAL DR STE 400
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City | MEMPHIS
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State | TN
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Zip | 38120-1431
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Country | US
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Telephone | 901-221-2266
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Fax |
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Provider Business Mailing Address
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Address Line | 7025 N SCOTTSDALE RD STE 200
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-3675
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | ALEXANDRA LEE KOLOSKUS
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Credential | JD
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Telephone | 720-276-7706
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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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