MEDICARE: COMFORTS OF LIFE HOME CARE 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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1811516826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORTS OF LIFE HOME CARE INC

Provider Business Mailing Address
First Line	:	1762 THIRD GREEN DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38116-8007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4523 MILLBRANCH RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38116-7437
Country	:	US
Telephone Number	:	901-846-9404
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANTAY MOEMEKE
Credential	:
Telephone Number	:	901-846-9404

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	04/09/2020

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Directions to “COMFORTS OF LIFE HOME CARE INC ” Practice Location

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