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General NPI Number Information
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NPI Number | 1396973186
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Entity Type | Organization
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Legal Business Name | MEMPHIS CENTER FOR INDEPENDENT LIVING
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 1633 MADISON AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-2506
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Country | US
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Telephone | 901-726-6404
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Fax | 901-726-6521
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Provider Business Mailing Address
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Address Line | 1633 MADISON AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-2506
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Country | US
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Telephone | 901-726-6404
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Fax | 901-726-6521
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DEBORAH CUNNINGHAM
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Credential |
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Telephone | 901-726-6404
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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 | 1000000004198
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License Number State | TN
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