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General NPI Number Information
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NPI Number | 1285398834
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Entity Type | Organization
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Legal Business Name | FRIENDS FOR LIFE CORPORATION
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Dates
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Enumeration Date | 10/28/2021
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 806 S COOPER ST
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City | MEMPHIS
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State | TN
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Zip | 38104-5406
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Country | US
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Telephone | 901-896-0739
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Fax |
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Provider Business Mailing Address
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Address Line | 1548 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-2432
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Country | US
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Telephone | 901-333-8269
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Fax | 901-333-8255
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Authorized Official
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Title or Position | CEO
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Name | DIANE DUKE
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Credential |
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Telephone | 747-230-7297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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