Healthcare Provider Details

I. General information

NPI: 1528711652
Provider Name (Legal Business Name): CORRI CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6044 LITTLE BROOK CIR N APT 105
MEMPHIS TN
38115-8307
US

IV. Provider business mailing address

6044 LITTLE BROOK CIR N APT 105
MEMPHIS TN
38115-8307
US

V. Phone/Fax

Practice location:
  • Phone: 901-212-9223
  • Fax:
Mailing address:
  • Phone: 901-212-9223
  • Fax:

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: MS. SOCCORRI LAKES
Title or Position: OWNER
Credential:
Phone: 901-212-9223