Healthcare Provider Details

I. General information

NPI: 1922565514
Provider Name (Legal Business Name): TTMSCARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 MEADOW RIDGE DR
CORDOVA TN
38016-8468
US

IV. Provider business mailing address

2373 MEADOW RIDGE DR
CORDOVA TN
38016-8468
US

V. Phone/Fax

Practice location:
  • Phone: 901-600-0664
  • Fax:
Mailing address:
  • Phone: 901-600-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: TENEKA TERIE MACON-SMITH
Title or Position: OWNER
Credential:
Phone: 901-600-0664