Healthcare Provider Details

I. General information

NPI: 1487913034
Provider Name (Legal Business Name): SUPPORTIVE LIVING CONCEPTS,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 OLD GETWELL RD
MEMPHIS TN
38118-3635
US

IV. Provider business mailing address

3391 OLD GETWELL RD
MEMPHIS TN
38118-3635
US

V. Phone/Fax

Practice location:
  • Phone: 901-949-0011
  • Fax:
Mailing address:
  • Phone: 901-949-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number00000000
License Number StateTN

VIII. Authorized Official

Name: MR. MICHAEL HAMPTON
Title or Position: CEO
Credential:
Phone: 901-949-0011