Healthcare Provider Details

I. General information

NPI: 1578998290
Provider Name (Legal Business Name): MARY C BRACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 VINTON AVE # 2
MEMPHIS TN
38104-0503
US

IV. Provider business mailing address

1307 VINTON AVE # 2
MEMPHIS TN
38104-0503
US

V. Phone/Fax

Practice location:
  • Phone: 901-304-4328
  • Fax:
Mailing address:
  • Phone: 901-304-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MARY C BRACY
Title or Position: HOME HEALTH PROVIDER/CEO
Credential:
Phone: 901-304-4328