1659759496 NPI number — HOME SWEET HOMECARE

Table of content: (NPI 1659759496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659759496 NPI number — HOME SWEET HOMECARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME SWEET HOMECARE
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:
1659759496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7955 CAMPTOWN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLIVE BRANCH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38654-1241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-356-1195
Provider Business Mailing Address Fax Number:
901-575-3328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 POPLAR AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38103-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-356-1195
Provider Business Practice Location Address Fax Number:
901-575-3328
Provider Enumeration Date:
05/13/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JEFFRIES
Authorized Official First Name:
KOBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
901-356-1195

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  1000000015160 , 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)