Healthcare Provider Details

I. General information

NPI: 1386442036
Provider Name (Legal Business Name): H.A.B.I.T.S 360, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 PLAYERS CLUB PKWY
MEMPHIS TN
38125-8845
US

IV. Provider business mailing address

131 S CENTER ST P.O BOX 285
COLLIERVILLE TN
38017
US

V. Phone/Fax

Practice location:
  • Phone: 901-878-5895
  • Fax: 346-205-0454
Mailing address:
  • Phone: 901-849-9932
  • Fax: 346-205-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIJUANA SALES
Title or Position: FNP
Credential:
Phone: 901-878-5895