MEDICARE: AVE MARIA HOME

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	313M00000X	Nursing Facility/Intermediate Care Facility	0000000232	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831250604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVE MARIA HOME

Provider Business Mailing Address
First Line	:	2805 CHARLES BRYAN RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-4756
Country	:	US
Telephone Number	:	901-386-3211
Fax Number	:	901-405-3783

Provider Business Practice Location Address
First Line	:	2805 CHARLES BRYAN RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-4756
Country	:	US
Telephone Number	:	901-386-3211
Fax Number	:	901-405-3783

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. FRANK GATTUSO
Credential	:
Telephone Number	:	901-386-3211

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	02/02/2009

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Directions to “AVE MARIA HOME ” Practice Location

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