MEDICARE: TKR RESIDENTIAL CARE HOME 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
1	261QA0600X	Adult Day Care Clinic/Center	L000000014512	TN

General Provider Information

NPI Number	:	1801117114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TKR RESIDENTIAL CARE HOME LLC

Provider Business Mailing Address
First Line	:	821 SHELBY AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3733
Country	:	US
Telephone Number	:	615-226-4454
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 SHELBY AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3733
Country	:	US
Telephone Number	:	615-226-4454
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND ADMINISTRATOR
Name	:	MS. TERRI DIANE RICHARDSON
Credential	:
Telephone Number	:	615-226-4454

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	04/29/2015

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