=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982593372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY LIFE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2025
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6074 APPLE TREE DR STE 14
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-0300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-707-0099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8496 WILKINSVILLE RD STE 101-157
-----------------------------------------------------
City | MILLINGTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38053-1546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-707-0099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LADORCAS EVANS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-707-0099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------