Healthcare Provider Details

I. General information

NPI: 1427280569
Provider Name (Legal Business Name): SUPPORT SOLUTIONS OF TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 SHELBY OAKS DR STE 100
MEMPHIS TN
38134-7318
US

IV. Provider business mailing address

5909 SHELBY OAKS DR STE 100
MEMPHIS TN
38134-7318
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-9193
  • Fax: 901-383-9195
Mailing address:
  • Phone: 901-383-9193
  • Fax: 901-383-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberPSS0000000274
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MISS ANGELIQUE VATOCO DILWORTH
Title or Position: BEHAVIOR ANALYST
Credential: MA
Phone: 901-383-9193