1316380686 NPI number — COURTESY CARE, INC.

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 1316380686 NPI number — COURTESY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COURTESY CARE, INC.
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:
1316380686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4154 MEADOW PARK CV
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:
38115-6630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-313-0044
Provider Business Mailing Address Fax Number:
901-255-2567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6099 MOUNT MORIAH ROAD EXT STE 9A
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:
38115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-313-0044
Provider Business Practice Location Address Fax Number:
901-255-2567
Provider Enumeration Date:
04/16/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOWZE
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
901-409-2577

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  L000000022386 , 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)

  • Identifier: H445453 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".