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General NPI Number Information
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NPI Number | 1205770203
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Entity Type | Organization
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Legal Business Name | TIARASHAVEN & SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 04/18/2026
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Last Update Date | 04/18/2026
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Provider Practice Location Address
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Address Line | 7533 DAISY GROVE DR APT 1
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City | CORDOVA
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State | TN
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Zip | 38016-3617
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Country | US
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Telephone | 901-647-0438
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Fax |
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Provider Business Mailing Address
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Address Line | 7533 DAISY GROVE DR APT 1
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City | CORDOVA
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State | TN
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Zip | 38016-3617
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Country | US
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Telephone | 901-647-0438
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Fax |
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Authorized Official
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Title or Position | MEMBER / ORGANIZER
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Name | DR. BRYAN KEITH SULLINS
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Credential | PHD
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Telephone | 901-647-0438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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