MEDICARE: QUEEN CITY HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1932758448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEEN CITY HOME CARE LLC

Provider Business Mailing Address
First Line	:	7755 OSCAR GREEN RD
Second Line	:
City	:	PRIMM SPRINGS
State	:	TN
Zip	:	38476-9636
Country	:	US
Telephone Number	:	615-369-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	7755 OSCAR GREEN RD
Second Line	:
City	:	PRIMM SPRINGS
State	:	TN
Zip	:	38476-9636
Country	:	US
Telephone Number	:	615-369-9899
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ROBERT BRIAN WHITE
Credential	:
Telephone Number	:	615-369-9899

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	09/06/2019

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Directions to “QUEEN CITY HOME CARE LLC ” Practice Location

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