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General NPI Number Information
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NPI Number | 1467825083
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Entity Type | Organization
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Legal Business Name | PROMISE GROVES ADULT DAY CENTER
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8556 MACON RD
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City | CORDOVA
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State | TN
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Zip | 38018-6100
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Country | US
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Telephone | 901-218-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 1057 KENTSHIRE CV
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City | CORDOVA
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State | TN
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Zip | 38018-7516
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Country | US
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Telephone | 901-218-2294
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIMBERLY NICOLE WESTON
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Credential |
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Telephone | 901-218-2294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | TN
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