Healthcare Provider Details

I. General information

NPI: 1659752103
Provider Name (Legal Business Name): COMMUNITY TRANSITION NURSE CARE MANAGER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3238 PLAYERS CLUB CIR STE 58&59
MEMPHIS TN
38125-8843
US

IV. Provider business mailing address

4405 TIMBER JUMP
MEMPHIS TN
38141-7395
US

V. Phone/Fax

Practice location:
  • Phone: 901-869-5744
  • Fax: 901-794-4128
Mailing address:
  • Phone: 901-550-1486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1000000016409
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADDIE MARCHANT
Title or Position: OWNER/CEO
Credential:
Phone: 901-550-1486