Healthcare Provider Details

I. General information

NPI: 1407025539
Provider Name (Legal Business Name): SUPPORT SOLUTIONS OF THE MID-SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 SHELBY OAKS DR SUITE 100
MEMPHIS TN
38134-7317
US

IV. Provider business mailing address

5909 SHELBY OAKS DR SUITE 100
MEMPHIS TN
38134-7317
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-9193
  • Fax: 901-383-9195
Mailing address:
  • Phone: 901-383-9193
  • Fax: 901-383-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberPSS0000000274
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberL3(20)4M4-038-6644
License Number StateTN

VIII. Authorized Official

Name: DR. LARRY DURBIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: EDD
Phone: 901-383-9193