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General NPI Number Information
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NPI Number | 1609327246
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Entity Type | Organization
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Legal Business Name | LD&H SPECIALIZED CARE SERVICES
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 2260 US-51 HELEN R TUCKER ADULT DEV CENTER
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City | RIPLEY
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State | TN
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Zip | 38063
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Country | US
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Telephone | 731-602-9512
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Fax | 731-635-3499
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Provider Business Mailing Address
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Address Line | 2260 US-51
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City | RIPLEY
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State | TN
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Zip | 38063
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Country | US
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Telephone | 731-602-9512
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Fax | 731-635-3499
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Authorized Official
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Title or Position | HEALTH ADMINISTRATOR
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Name | LISA DESIREE HARDING
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Credential |
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Telephone | 731-602-9512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 1000000018834
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License Number State | TN
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