=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962722165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AN EXTRA PAIR OF HANDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2010
-----------------------------------------------------
Last Update Date | 06/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3340 POPLAR AVE STE 221
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38111-4680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-323-7601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3340 POPLAR AVE STE 221
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38111-4680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-323-7601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTIE MORRIS BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-949-3871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 110001797
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------