Healthcare Provider Details

I. General information

NPI: 1306661327
Provider Name (Legal Business Name): LEE HAMILTON CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 DUNN AVE
MEMPHIS TN
38117-6512
US

IV. Provider business mailing address

3340 GREENWAY DR
HORN LAKE MS
38637-2642
US

V. Phone/Fax

Practice location:
  • Phone: 573-481-5473
  • Fax: 872-312-0821
Mailing address:
  • Phone: 573-481-5473
  • Fax: 872-312-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: JEREMIAH WHITE SR.
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 573-481-5473