Providence Companion Care of TN 1, LLC

Key facts

NPI

1639623754

Entity type

Organization (NPI type 2)

Primary specialty

In Home Supportive Care Agency 253Z00000X

License

I000000018767 (TN)

Legal business name

PROVIDENCE COMPANION CARE OF TN 1, LLC

Practice address

600 N State of Franklin Rd
Suite 10
Johnson City, TN 37604-8226

Phone

(423) 220-1266

Fax

(866) 404-0950

NPI assigned

Aug 5, 2016

Organization subpart

No

Authorized official

Name

Hunter L Simpson

Title

Managing Partner

Phone

(423) 220-1266

National Provider Directory

Specialties & licenses

Addresses

Other names

• Providence Companion Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 5, 2016.

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470355200000",
    "number": "1639623754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 10",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376048226",
            "telephone_number": "423-220-1266",
            "fax_number": "866-404-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 10",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376048226",
            "telephone_number": "423-220-1266",
            "fax_number": "866-404-0950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE COMPANION CARE OF TN 1, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2016-08-05",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "HUNTER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "423-220-1266"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "TN",
            "license": "I000000018767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Companion Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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