MEDICARE: AT YOUR RESIDENCE HEALTH CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	16331	TN

General Provider Information

NPI Number	:	1114302312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT YOUR RESIDENCE HEALTH CARE SERVICES

Provider Business Mailing Address
First Line	:	1665 BONNIE LN
Second Line	:	106
City	:	CORDOVA
State	:	TN
Zip	:	38016-0548
Country	:	US
Telephone Number	:	901-800-2770
Fax Number	:	901-800-2771

Provider Business Practice Location Address
First Line	:	1665 BONNIE LN
Second Line	:	106
City	:	CORDOVA
State	:	TN
Zip	:	38016-0548
Country	:	US
Telephone Number	:	901-800-2770
Fax Number	:	901-800-2771

Authorized Official
Title or Position	:	OWNER
Name	:	RAVEN MARSHALL
Credential	:
Telephone Number	:	901-800-2770

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	07/29/2015

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