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General NPI Number Information
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NPI Number | 1346695194
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Entity Type | Organization
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Legal Business Name | MANNA FOOD 4 LIFE
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 860 TATUM RD
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City | MEMPHIS
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State | TN
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Zip | 38122-2543
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Country | US
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Telephone | 901-215-5294
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Fax | 901-454-1442
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Provider Business Mailing Address
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Address Line | 860 TATUM RD
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City | MEMPHIS
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State | TN
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Zip | 38122-2543
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ORLENDA T WILLIAMS
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Credential |
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Telephone | 901-215-5294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 115004719
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License Number State | TN
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