Healthcare Provider Details

I. General information

NPI: 1154093037
Provider Name (Legal Business Name): YAYA'S PLACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 10/09/2021
Certification Date: 10/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 OLD DEXTER RD STE 103
CORDOVA TN
38016-0542
US

IV. Provider business mailing address

8200 OLD DEXTER RD STE 103
CORDOVA TN
38016-0542
US

V. Phone/Fax

Practice location:
  • Phone: 901-859-9830
  • Fax:
Mailing address:
  • Phone: 901-859-9830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAVEN MARSHALL
Title or Position: OWNER
Credential:
Phone: 901-859-9830