Healthcare Provider Details

I. General information

NPI: 1760865927
Provider Name (Legal Business Name): GIFTED HEARTS AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 BLUEFIELD ST
MEMPHIS TN
38128-4831
US

IV. Provider business mailing address

3217 BLUEFIELD ST
MEMPHIS TN
38128-4831
US

V. Phone/Fax

Practice location:
  • Phone: 901-331-4414
  • Fax: 901-353-2315
Mailing address:
  • Phone: 901-331-4414
  • Fax: 901-353-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA E PRICE
Title or Position: OWNER/ MANAGER
Credential:
Phone: 901-331-4414