MEDICARE: 901 IN HOME CARE L.L.C.

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

General Provider Information

NPI Number	:	1912509407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	901 IN HOME CARE L.L.C.

Provider Business Mailing Address
First Line	:	4955 GERTRUDE DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-5753
Country	:	US
Telephone Number	:	901-221-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 MOUNT MORIAH RD STE H234
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1515
Country	:	US
Telephone Number	:	901-221-2991
Fax Number	:	901-339-6674

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA BURDETTE
Credential	:
Telephone Number	:	901-221-2991

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/02/2022

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