Healthcare Provider Details

I. General information

NPI: 1235815903
Provider Name (Legal Business Name): WESERV HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 RIDGEWAY CENTER PKWY STE 300
MEMPHIS TN
38120-4014
US

IV. Provider business mailing address

5865 RIDGEWAY CENTER PKWY STE 300
MEMPHIS TN
38120-4014
US

V. Phone/Fax

Practice location:
  • Phone: 901-209-0882
  • Fax: 901-209-0882
Mailing address:
  • Phone: 901-209-0882
  • Fax: 901-209-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. RETISA JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 901-209-0882