Healthcare Provider Details

I. General information

NPI: 1053811398
Provider Name (Legal Business Name): SENIOR ENHANCEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5724 STAGE RD STE F
BARTLETT TN
38134-4572
US

IV. Provider business mailing address

4630 ORANGE TULIP DR
MEMPHIS TN
38135-0749
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-0417
  • Fax:
Mailing address:
  • Phone: 901-383-0417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1617T
License Number StateTN

VIII. Authorized Official

Name: MARSHA LEAKE
Title or Position: OWNER/COO
Credential:
Phone: 901-383-0417