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General NPI Number Information
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NPI Number | 1053003111
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Entity Type | Organization
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Legal Business Name | MIDSOUTH ESSENTIAL SHARED GROUP LIVING
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 610 N. MISSOUR ST.
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City | WEST MEMPHIS
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State | AR
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Zip | 72364-5007
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Country | US
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Telephone | 870-301-2022
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Fax | 901-441-5885
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Provider Business Mailing Address
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Address Line | 610 N. MISSOUR ST.
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City | WEST MEMPHIS
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State | AR
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Zip | 72364
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Country | US
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Telephone | 870-301-2022
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Fax | 901-441-5885
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | SCARLETT HUNTER
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Credential |
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Telephone | 901-574-8207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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