MEDICARE: SANDRA'S HOME HEALTH CARE

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	251E00000X	Home Health Agency	1000000009371	TN

General Provider Information

NPI Number	:	1508141649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA'S HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	3540 SUMMER AVE
Second Line	:	SUITE 404
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3600
Country	:	US
Telephone Number	:	901-324-6164
Fax Number	:	901-324-6164

Provider Business Practice Location Address
First Line	:	3540 SUMMER AVE
Second Line	:	SUITE 404
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3600
Country	:	US
Telephone Number	:	901-324-6164
Fax Number	:	901-324-6164

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SANDRA WILLIAMS
Credential	:
Telephone Number	:	901-643-2872

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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