Healthcare Provider Details

I. General information

NPI: 1851786040
Provider Name (Legal Business Name): NEW VISION SUPPORT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 UNION AVE SUITE 932
MEMPHIS TN
38104-3513
US

IV. Provider business mailing address

1331 UNION AVE SUITE 932
MEMPHIS TN
38104-3513
US

V. Phone/Fax

Practice location:
  • Phone: 901-319-5983
  • Fax:
Mailing address:
  • Phone: 901-319-5983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. WAKETA YVETTE CARPENTER
Title or Position: OWNER
Credential:
Phone: 901-319-5983