Healthcare Provider Details

I. General information

NPI: 1598513475
Provider Name (Legal Business Name): BRENDA GRACEFUL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3173 KIRBY WHITTEN RD STE 204
BARTLETT TN
38134-2881
US

IV. Provider business mailing address

3173 KIRBY WHITTEN RD STE 204
BARTLETT TN
38134-2881
US

V. Phone/Fax

Practice location:
  • Phone: 901-498-0844
  • Fax: 901-205-0794
Mailing address:
  • Phone: 901-270-9497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE FOSTER
Title or Position: OWNER
Credential:
Phone: 901-270-9497