1801171095 NPI number — PERSONALIZED CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801171095 NPI number — PERSONALIZED CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONALIZED CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801171095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5349 ESTATE OFFICE DR., STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-385-7787
Provider Business Mailing Address Fax Number:
901-415-6261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7512 CORPORATE CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138-3864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-385-7787
Provider Business Practice Location Address Fax Number:
901-415-6261
Provider Enumeration Date:
10/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
901-385-7787

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  I000000009356 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com