MEDICARE: SUPPORT SOLUTIONS OF TENNESSEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency	PSS0000000274	TN
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1427280569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORT SOLUTIONS OF TENNESSEE

Provider Business Mailing Address
First Line	:	5909 SHELBY OAKS DR STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7318
Country	:	US
Telephone Number	:	901-383-9193
Fax Number	:	901-383-9195

Provider Business Practice Location Address
First Line	:	5909 SHELBY OAKS DR STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7318
Country	:	US
Telephone Number	:	901-383-9193
Fax Number	:	901-383-9195

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	MISS ANGELIQUE VATOCO DILWORTH
Credential	:	MA
Telephone Number	:	901-383-9193

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/21/2009

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