Healthcare Provider Details

I. General information

NPI: 1508780206
Provider Name (Legal Business Name): SEASONS OF GRACE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3086 RUBY LN
MEMPHIS TN
38111-2936
US

IV. Provider business mailing address

3086 RUBY LN
MEMPHIS TN
38111-2936
US

V. Phone/Fax

Practice location:
  • Phone: 901-315-2668
  • Fax:
Mailing address:
  • Phone: 901-315-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LA TONYA EVETTE ANDERSON
Title or Position: EXECUTIVE DIRECTOR, CCO
Credential: CPHT, BS, MBA
Phone: 901-315-2668