Healthcare Provider Details

I. General information

NPI: 1194776716
Provider Name (Legal Business Name): SHELBY HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 JAMES RD
MEMPHIS TN
38127-8806
US

IV. Provider business mailing address

485 CENTRAL AVE NE
CLEVELAND TN
37311-5541
US

V. Phone/Fax

Practice location:
  • Phone: 901-358-1707
  • Fax: 901-358-1788
Mailing address:
  • Phone: 423-478-5953
  • Fax: 423-479-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0248
License Number StateTN

VIII. Authorized Official

Name: MR. JEFF CANTRELL
Title or Position: PRESIDENT
Credential:
Phone: 423-478-5953