=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336458066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATURAL STRENGTH DEVELOPMENT CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2010
-----------------------------------------------------
Last Update Date | 09/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3145 HICKORY HILL RD SUITE 104
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-2518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-451-2999
-----------------------------------------------------
Fax | 901-380-2767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3145 HICKORY HILL RD SUITE 104
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-2518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-451-2999
-----------------------------------------------------
Fax | 901-380-2767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT CFO
-----------------------------------------------------
Name | MS. TAMMY J PERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-451-2999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 109003913
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------