Healthcare Provider Details

I. General information

NPI: 1609634492
Provider Name (Legal Business Name): SANCTUARY AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 SUMMER AVE STE 323
MEMPHIS TN
38122-3693
US

IV. Provider business mailing address

2613 PARKVIEW DR
MEMPHIS TN
38128-7708
US

V. Phone/Fax

Practice location:
  • Phone: 901-480-7884
  • Fax:
Mailing address:
  • Phone: 708-270-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY PEARSON
Title or Position: OWNER
Credential:
Phone: 708-270-3853