=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790617041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAWANNAH BROWN ELDER CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2026
-----------------------------------------------------
Last Update Date | 06/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 682 CREEKSTONE CIR
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38127-2051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-671-6607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 682 CREEKSTONE CIR
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38127-2051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-671-6607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOME HEALTH MANAGER
-----------------------------------------------------
Name | SHAWANNAH R BROWN
-----------------------------------------------------
Credential | BLS) & CPR CERTIFICA
-----------------------------------------------------
Telephone | 901-647-9465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------