Healthcare Provider Details

I. General information

NPI: 1033206875
Provider Name (Legal Business Name): CRISTASH HOME CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 PALMER RD
MEMPHIS TN
38116-7717
US

IV. Provider business mailing address

4384 STAGE RD SUITE 201
MEMPHIS TN
38128-5794
US

V. Phone/Fax

Practice location:
  • Phone: 901-396-0216
  • Fax:
Mailing address:
  • Phone: 901-396-0216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY DEON FRANKLIN
Title or Position: PRESIDENT
Credential:
Phone: 901-396-0216