Healthcare Provider Details

I. General information

NPI: 1588299960
Provider Name (Legal Business Name): BLEDSOE PREMIER HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6094 APPLE TREE DR STE 8
MEMPHIS TN
38115-0306
US

IV. Provider business mailing address

6094 APPLE TREE DR STE 8
MEMPHIS TN
38115-0306
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-3339
  • Fax: 901-368-3340
Mailing address:
  • Phone: 901-368-3339
  • Fax: 901-368-3340

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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ALTHESIA SHAWAUNN BLEDSOE
Title or Position: OWNER
Credential:
Phone: 319-457-5888