Provider Demographics
NPI:1225038011
Name:RHA TENNESSEE GROUP HOMES
Entity type:Organization
Organization Name:RHA TENNESSEE GROUP HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:IZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-895-7788
Mailing Address - Street 1:3606 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5884
Mailing Address - Country:US
Mailing Address - Phone:615-849-7735
Mailing Address - Fax:
Practice Address - Street 1:3350 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0208
Practice Address - Country:US
Practice Address - Phone:615-895-7788
Practice Address - Fax:615-895-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL323-117-4122315P00000X
TNL 320-015-600320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN70447096Medicaid