1871625749 NPI number — BRENDA RICHARDSON MEMORIAL ACRE HOMES

Table of content: (NPI 1871625749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871625749 NPI number — BRENDA RICHARDSON MEMORIAL ACRE HOMES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRENDA RICHARDSON MEMORIAL ACRE HOMES
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:
BRMCH LLC
Provider Other Organization Name Type Code:
5
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:
1871625749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 STAGE RD
Provider Second Line Business Mailing Address:
SUITE #2
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38134-3161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-388-3545
Provider Business Mailing Address Fax Number:
901-388-3423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 STAGE RD
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134-3161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-388-3545
Provider Business Practice Location Address Fax Number:
901-388-3423
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WESTBROOKS
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
SUZZETTE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
901-388-3545

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  L3(20)4M3-066-6254 , 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)





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