| Itavia's House Of Care Llc | |
|
10543 Cedar Grove Rd Ste 150 Smyrna TN 37167-6525 | |
| (615) 905-6321 | |
| Not Available |
| Full Name | Itavia's House Of Care Llc |
|---|---|
| Speciality | In Home Supportive Care |
| Location | 10543 Cedar Grove Rd Ste 150, Smyrna, Tennessee |
| Authorized Official Name and Position | Alicia Michelle Ellis (OWNER/CEO) |
| Authorized Official Contact | 6159056321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Itavia's House Of Care Llc 10543 Cedar Grove Rd Ste 150 Smyrna TN 37167-6525 Ph: (615) 905-6321 | Itavia's House Of Care Llc 10543 Cedar Grove Rd Ste 150 Smyrna TN 37167-6525 Ph: (615) 905-6321 |
| NPI Number | 1083284814 |
|---|---|
| Provider Enumeration Date | 06/24/2021 |
| Last Update Date | 06/10/2022 |
| Certification Date | 05/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083284814 | NPI | - | NPPES |
| Q034586 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Primary |
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