Healthcare Provider Details

I. General information

NPI: 1447536875
Provider Name (Legal Business Name): CHILDREN'S BUREAU INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 N MANASSAS ST
MEMPHIS TN
38107-2516
US

IV. Provider business mailing address

868 N MANASSAS ST
MEMPHIS TN
38107-2516
US

V. Phone/Fax

Practice location:
  • Phone: 901-577-2500
  • Fax: 901-577-2506
Mailing address:
  • Phone: 901-577-2500
  • Fax: 901-577-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSO/10717A
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberSO/10718A
License Number StateTN

VIII. Authorized Official

Name: MR. SEAN MARTIN LEE
Title or Position: PRESIDENT
Credential:
Phone: 901-577-2500