Healthcare Provider Details

I. General information

NPI: 1114850609
Provider Name (Legal Business Name): LADY OF JEMS ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 PARK CREST CV # 100
CORDOVA TN
38016-2494
US

IV. Provider business mailing address

2750 PARK CREST CV # 100
CORDOVA TN
38016-2494
US

V. Phone/Fax

Practice location:
  • Phone: 800-772-3097
  • Fax: 888-210-0790
Mailing address:
  • Phone: 800-772-3097
  • Fax: 888-210-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CELESTA JEMISON
Title or Position: CEO
Credential:
Phone: 800-772-3097