Provider Demographics
NPI:1154600807
Name:PAULINE & THOMAS HEALTHCARE, INC
Entity type:Organization
Organization Name:PAULINE & THOMAS HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MMBAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-896-8231
Mailing Address - Street 1:1943 ALMAVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5784
Mailing Address - Country:US
Mailing Address - Phone:615-896-8231
Mailing Address - Fax:615-462-7101
Practice Address - Street 1:1943 ALMAVILLE RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5784
Practice Address - Country:US
Practice Address - Phone:615-896-8231
Practice Address - Fax:615-462-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL00000000774251E00000X
TNL000000007744385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445552Medicaid