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General NPI Number Information
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NPI Number | 1295617710
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Entity Type | Organization
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Legal Business Name | MINNIES HAVEN OF HOPE ADULT CARE LLC
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 3754 SHADY HOLLOW LN
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City | MEMPHIS
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State | TN
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Zip | 38116-4039
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Country | US
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Telephone | 901-230-4409
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 EDWIN CT
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City | MCDONOUGH
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State | GA
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Zip | 30252-5018
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Country | US
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Telephone | 901-230-4409
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELA AVANT - WOODARD
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Credential |
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Telephone | 901-230-4409
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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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