Organization
HOME CAREGIVERS OF COOKEVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KONSTANTIN YEPIFANTSEV (OWNER)
(931) 528-8585
Entity
Organization
Contact information
Practice address
118 S DIXIE AVE, SUITE 24, COOKEVILLE, TN 38501-3405
(931) 528-8585
Mailing address
118 S DIXIE AVE, SUITE 24, COOKEVILLE, TN 38501-3405
(931) 528-8585
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
L4380963546
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0445769
TENNCARE
TN
Enumeration date
03/26/2017
Last updated
03/26/2017
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