Healthcare Provider Details

I. General information

NPI: 1154696151
Provider Name (Legal Business Name): SHEPHERD'S HAVEN MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SHEPHERDS HAVEN WAY
ARLINGTON TN
38002-4257
US

IV. Provider business mailing address

2000 APPLING RD
CORDOVA TN
38016-4910
US

V. Phone/Fax

Practice location:
  • Phone: 901-347-5296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateTN

VIII. Authorized Official

Name: SUSAN BABIN
Title or Position: DIRECTOR
Credential:
Phone: 901-347-5296