Healthcare Provider Details

I. General information

NPI: 1306367115
Provider Name (Legal Business Name): OUR HOUSE TOO ADULT DAY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5766 PECAN TRCE
BARTLETT TN
38135-0249
US

IV. Provider business mailing address

5766 PECAN TRCE
BARTLETT TN
38135-0249
US

V. Phone/Fax

Practice location:
  • Phone: 901-500-4969
  • Fax: 662-873-2673
Mailing address:
  • Phone: 901-500-4969
  • Fax: 662-873-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. SHELIA COLEMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 901-500-4969