1194943514 NPI number — SHELBY RESIDENTIAL AND VOCATIONAL SERVICES

Table of content: (NPI 1194943514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194943514 NPI number — SHELBY RESIDENTIAL AND VOCATIONAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELBY RESIDENTIAL AND VOCATIONAL SERVICES
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:
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:
1194943514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3971 KNIGHT ARNOLD RD
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:
38118-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-869-7787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3971 KNIGHT ARNOLD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38118-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-869-7787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DURBIN
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
901-821-1067

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  L323-066-6232 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315P00000X , with the licence number: L323-066-6234 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: L323-066-6235 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: L323-066-6236 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: L323-066-6237 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: L323-066-6238 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: L323-066-6239 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: L323-066-6244 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7447075 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447076 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447078 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447077 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447080 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447079 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447081 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7447082 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".