Healthcare Provider Details

I. General information

NPI: 1821570144
Provider Name (Legal Business Name): EACH1 PERSONAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CARLTON PL
JACKSON TN
38305-7938
US

IV. Provider business mailing address

22 CARLTON PL
JACKSON TN
38305-7938
US

V. Phone/Fax

Practice location:
  • Phone: 901-574-3581
  • Fax:
Mailing address:
  • Phone: 901-574-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0100407
License Number StateTN

VIII. Authorized Official

Name: MS. ANGELICA ROSS
Title or Position: OWNER
Credential: C.N.A.
Phone: 901-574-3581