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General NPI Number Information
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NPI Number | 1972308344
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Entity Type | Organization
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Legal Business Name | WILSHIRE SUPPORTIVE LIVING HOME
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 937 MAPLE DR
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City | MEMPHIS
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State | TN
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Zip | 38108-3230
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Country | US
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Telephone | 901-215-4387
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Fax |
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Provider Business Mailing Address
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Address Line | 4345 OAK CHASE CV
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City | MEMPHIS
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State | TN
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Zip | 38125-2912
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Country | US
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Telephone | 901-215-4387
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ALFRED MICHAEL MOORE
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Credential | BSW
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Telephone | 901-215-4387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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