Basic Information
| Provider Information | |||||||||
| NPI: | 1861435471 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINISTRY HOME CARE, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CADILLAC DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370271001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178414834 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1571 HIGHWAY 51 NORTH | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ARBOR VITAE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153568805 | ||||||||
| FaxNumber: | 7153568875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | ADKINS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP, CHIEF LEGAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6153095668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 1509 | WI | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 43189300 | 05 | WY | MEDICAID |