Healthcare Provider Details

I. General information

NPI: 1609784461
Provider Name (Legal Business Name): WATERS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 PATRICK RD
MEMPHIS TN
38114-5832
US

IV. Provider business mailing address

1802 PATRICK RD
MEMPHIS TN
38114-5832
US

V. Phone/Fax

Practice location:
  • Phone: 901-779-0879
  • Fax: 901-779-0879
Mailing address:
  • Phone: 901-779-0879
  • Fax: 901-779-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER WATERS
Title or Position: OWNER
Credential:
Phone: 901-779-0879