Healthcare Provider Details

I. General information

NPI: 1265304877
Provider Name (Legal Business Name): BHW ESTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 LUCY AVE
MEMPHIS TN
38106-2714
US

IV. Provider business mailing address

2026 BELOVER DR
MEMPHIS TN
38127-3302
US

V. Phone/Fax

Practice location:
  • Phone: 901-288-0787
  • Fax:
Mailing address:
  • Phone: 901-288-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBRA HOGUE BRANTLEY
Title or Position: PRESIDENT
Credential:
Phone: 901-288-0787