Healthcare Provider Details

I. General information

NPI: 1013409853
Provider Name (Legal Business Name): CHOSEN VESSEL MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 STAGE OAKS DRIVE SUITE 4
BARTLETT TN
38134
US

IV. Provider business mailing address

6551 STAGE OAKS DRIVE SUITE 4
BARTLETT TN
38134
US

V. Phone/Fax

Practice location:
  • Phone: 901-361-4763
  • Fax: 901-379-8461
Mailing address:
  • Phone: 901-361-4763
  • Fax: 901-379-8461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberI000000022219
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License NumberI000000022219
License Number StateTN

VIII. Authorized Official

Name: LINDA LOUISE BARNES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 901-361-4763