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Organization
LACY CARE FACILITY
Active
Organization
LACY CARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY BRADFORD (CO-OWNER/PARTNERSHIP)
(901) 268-7531
Entity
Organization
Contact information
Practice address
3533 KENDRICK RD, MEMPHIS, TN 38108-2026
(901) 372-3327
Mailing address
3533 KENDRICK RD, MEMPHIS, TN 38108-2026
(901) 372-3327
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
L000000005891
TN
311ZA0620X
Adult Care Home Facility
L000000005891
TN
Other
Enumeration date
07/06/2010
Last updated
07/06/2010
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