Healthcare Provider Details

I. General information

NPI: 1073299285
Provider Name (Legal Business Name): DEMETRIA DENISE BAILEY ADMINISTRATOR RHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2849 SHADY OAK AVE
MEMPHIS TN
38112-4656
US

IV. Provider business mailing address

2849 SHADY OAK AVE
MEMPHIS TN
38112-4656
US

V. Phone/Fax

Practice location:
  • Phone: 901-340-4623
  • Fax: 901-370-2268
Mailing address:
  • Phone: 901-340-4623
  • Fax: 901-370-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberL000000041159
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: