Healthcare Provider Details

I. General information

NPI: 1356590202
Provider Name (Legal Business Name): URBAN FAMILY MINISTRIES CDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 LAMAR AVE
MEMPHIS TN
38114-2203
US

IV. Provider business mailing address

2174 LAMAR AVE
MEMPHIS TN
38114-2203
US

V. Phone/Fax

Practice location:
  • Phone: 901-323-8400
  • Fax: 901-405-1235
Mailing address:
  • Phone: 901-323-8400
  • Fax: 901-405-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1000000002519
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1000000002519
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1000000002519
License Number StateTN

VIII. Authorized Official

Name: MR. JERRY LEE IVERY SR.
Title or Position: EXECUTIVE DIRECTOR
Credential: BA, MS
Phone: 901-323-8400