=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023401692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOR EVER ANGELS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2015
-----------------------------------------------------
Last Update Date | 03/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2997 KNIGHT RD
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38118-3169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-859-6252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2997 KNIGHT RD
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38118-3169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-859-6252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. SHARON TUNSTALL MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-859-6252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 111004435
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------