MEDICARE: AN EXTRA PAIR OF HANDS

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	253Z00000X	In Home Supportive Care Agency	1000000022211	TN

General Provider Information

NPI Number	:	1508356874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AN EXTRA PAIR OF HANDS

Provider Business Mailing Address
First Line	:	6510 STAGE RD STE 2
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-3892
Country	:	US
Telephone Number	:	901-643-5120
Fax Number	:	901-643-5120

Provider Business Practice Location Address
First Line	:	6510 STAGE RD STE 2
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-3892
Country	:	US
Telephone Number	:	901-643-5120
Fax Number	:	901-643-5120

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MATTIE B BROWN
Credential	:
Telephone Number	:	901-949-3871

Provider Enumeration Date	:	05/12/2018
Last Update Date	:	05/12/2018

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Directions to “AN EXTRA PAIR OF HANDS ” Practice Location

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