Healthcare Provider Details

I. General information

NPI: 1467092932
Provider Name (Legal Business Name): MSHN ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 FLETCHER CREEK DR STE 101
MEMPHIS TN
38133-7060
US

IV. Provider business mailing address

2057 FLETCHER CREEK DR
MEMPHIS TN
38133-7059
US

V. Phone/Fax

Practice location:
  • Phone: 901-410-9062
  • Fax:
Mailing address:
  • Phone: 901-825-8972
  • Fax: 901-729-6169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER GLENN STEPHENSON
Title or Position: CIO
Credential:
Phone: 901-410-9062