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NPI Code Detail

MEDICARE: LIVING LEGACY, INC.

MEDICARE: LIVING LEGACY, INC.
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
1104100000XSocial Worker
2251V00000XVoluntary or Charitable AgencyLMSW0000006120TN
3101Y00000XCounselor

General Provider Information

NPI Number : 1447492699
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVING LEGACY, INC.
Provider Business Mailing Address
First Line : 5865 RIDGEWAY CENTER PKWY STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-4014
Country : US
Telephone Number : 901-672-7857
Fax Number : 615-658-4559
Provider Business Practice Location Address
First Line : 5865 RIDGEWAY CENTER PKWY STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-4014
Country : US
Telephone Number : 901-672-7857
Fax Number : 615-658-4559
Authorized Official
Title or Position : DIRECTOR
Name : DR. SELENA NICOLE SMITH
Credential : PH.D., LAPSW,LADACII
Telephone Number : 901-672-7857
Provider Enumeration Date : 04/02/2009
Last Update Date : 02/19/2021

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