Healthcare Provider Details

I. General information

NPI: 1699921155
Provider Name (Legal Business Name): TAYLOR BROWN GARDEN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 POPLAR AVE
MEMPHIS TN
38105-4510
US

IV. Provider business mailing address

568 POPLAR AVE
MEMPHIS TN
38105-4510
US

V. Phone/Fax

Practice location:
  • Phone: 901-527-2411
  • Fax: 901-527-2413
Mailing address:
  • Phone: 901-527-2411
  • Fax: 901-527-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number1000000005282
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. IVORY L TAYLOR
Title or Position: CEO
Credential: PHD
Phone: 901-527-2411