Basic Information
| Provider Information | |||||||||
| NPI: | 1235293655 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VANDERBILT HOME CARE SERVICES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VANDERBILT HOME CARE SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 BELCOURT AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159360336 | ||||||||
| FaxNumber: | 6159360352 | ||||||||
| Practice Location | |||||||||
| Address1: | 2120 BELCOURT AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159360336 | ||||||||
| FaxNumber: | 6159360352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 05/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | GILLIHAN | ||||||||
| AuthorizedOfficialFirstName: | KERRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 6159360390 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 00000065 | TN | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | TNH184 | 01 | TN | OASIS IDENTIFIER | OTHER | 00000065 | 01 | TN | FACILITY LICENSE NUMBER | OTHER |