Healthcare Provider Details

I. General information

NPI: 1275785537
Provider Name (Legal Business Name): ODESSA'S FOSTER CARE HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 WILLIAMS
MEMPHIS TN
38126-0001
US

IV. Provider business mailing address

694 WILLIAMS AVE.
MEMPHIS TN
38126-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-947-2136
  • Fax: 901-947-6680
Mailing address:
  • Phone: 901-947-2136
  • Fax: 901-947-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS ODESSA A. WILLIAMSON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 901-947-2136