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General NPI Number Information
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NPI Number | 1881624476
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Entity Type | Organization
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Legal Business Name | DYERSBURG HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 1937 COOK ST
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City | DYERSBURG
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State | TN
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Zip | 38024-1882
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Country | US
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Telephone | 731-287-2307
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Fax | 731-287-2174
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Provider Business Mailing Address
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Address Line | 1937 COOK ST
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City | DYERSBURG
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State | TN
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Zip | 38024-1882
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Country | US
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Telephone | 731-287-2307
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Fax | 731-287-2174
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Authorized Official
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Title or Position | AUTH OFFICIAL
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Name | LAURIE HOLTSFORD
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Credential |
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Telephone | 615-465-7466
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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 | 0000000077
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License Number State | TN
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