Healthcare Provider Details

I. General information

NPI: 1184313058
Provider Name (Legal Business Name): NERCHER OLDER ADULT COMMUNITY RESOURCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 INTERNATIONAL DR STE 400
MEMPHIS TN
38120-1431
US

IV. Provider business mailing address

PO BOX 351
BRUNSWICK TN
38014-0351
US

V. Phone/Fax

Practice location:
  • Phone: 901-297-6579
  • Fax:
Mailing address:
  • Phone: 901-297-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIE ROBINSON
Title or Position: PRESIDENT
Credential: MSW, CDP
Phone: 901-297-6579