Healthcare Provider Details

I. General information

NPI: 1669149233
Provider Name (Legal Business Name): ABUNDANT FAITH HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 CARNES AVE
MEMPHIS TN
38111-4208
US

IV. Provider business mailing address

1461 KIRBY PKWY
MEMPHIS TN
38120-3454
US

V. Phone/Fax

Practice location:
  • Phone: 901-304-8355
  • Fax:
Mailing address:
  • Phone: 901-304-8355
  • 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: ELLEN BROWN
Title or Position: OWNER
Credential:
Phone: 901-304-8355