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General NPI Number Information
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NPI Number | 1295415099
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Entity Type | Organization
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Legal Business Name | J.A.L. SUPPORTIVE CARE HOMES
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 3898 MARY LEE DR
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City | MEMPHIS
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State | TN
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Zip | 38116-5718
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Country | US
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Telephone | 901-623-6220
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Fax |
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Provider Business Mailing Address
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Address Line | 3540 SUMMER AVE STE 310
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City | MEMPHIS
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State | TN
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Zip | 38122-3632
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Country | US
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Telephone | 901-623-6220
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Fax |
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Authorized Official
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Title or Position | CEO DIRECTOR
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Name | MRS. LETICIA ROSS-GLASS
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Credential |
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Telephone | 901-623-6220
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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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