=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528102464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOWENSTEIN HOUSE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 11/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 821 S BARKSDALE ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38114-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-274-5486
-----------------------------------------------------
Fax | 901-278-6927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 821 S BARKSDALE ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38114-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-274-5486
-----------------------------------------------------
Fax | 901-278-6927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | BILLY HEARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-274-5486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | L 229-106-6380
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------