Healthcare Provider Details

I. General information

NPI: 1013313865
Provider Name (Legal Business Name): SHELBY COUNTY HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE 3RD FLOOR, ADAMS PAVILION
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

877 JEFFERSON AVE 3RD FLOOR, ADAMS PAVILION
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number405
License Number StateTN

VIII. Authorized Official

Name: MS. REBECCA D DEROUSSE
Title or Position: ADMINISTRATOR
Credential:
Phone: 901-515-4300