Provider Demographics
NPI:1336614973
Name:YOUR HOME TEAM CARE, LLC
Entity type:Organization
Organization Name:YOUR HOME TEAM CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STALEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:865-604-5071
Mailing Address - Street 1:PO BOX 11772
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-1772
Mailing Address - Country:US
Mailing Address - Phone:865-604-5071
Mailing Address - Fax:
Practice Address - Street 1:6130 LONAS DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3233
Practice Address - Country:US
Practice Address - Phone:865-604-5071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care