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NPI Code Detail

MEDICARE: STAFFCO OF EASTERN TENNESSEE, LLC.

MEDICARE: STAFFCO OF EASTERN TENNESSEE, LLC.
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
1251E00000XHome Health AgencyL000000005138TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000005138OTHERTNSTATE OF TENNESSEE DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES

General Provider Information

NPI Number : 1447588579
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAFFCO OF EASTERN TENNESSEE, LLC.
Provider Business Mailing Address
First Line : 2654 PEERLESS RD NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-3732
Country : US
Telephone Number : 423-473-9922
Fax Number : 423-473-9924
Provider Business Practice Location Address
First Line : 2654 PEERLESS RD NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-3732
Country : US
Telephone Number : 423-473-9922
Fax Number : 423-473-9924
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. JASON NIPPS
Credential : B.S.
Telephone Number : 423-473-9922
Provider Enumeration Date : 12/01/2009
Last Update Date : 12/01/2009

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Directions to “STAFFCO OF EASTERN TENNESSEE, LLC. ” Practice Location

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