Healthcare Provider Details

I. General information

NPI: 1770131260
Provider Name (Legal Business Name): APPLE GROVE ALZHEIMER'S & DEMENTIA RESIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 HACKS CROSS RD
MEMPHIS TN
38125-8803
US

IV. Provider business mailing address

3575 HACKS CROSS RD
MEMPHIS TN
38125-8803
US

V. Phone/Fax

Practice location:
  • Phone: 901-755-1244
  • Fax: 901-755-1233
Mailing address:
  • Phone: 901-755-1244
  • Fax: 901-755-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MELISSA L. BEALL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 901-755-1244