Organization
PROVIDENCE HOME AND COMMUNITY LIVING SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JASMINE DENNIS (ADMINISTRATOR)
(901) 791-6041
Entity
Organization
Contact information
Practice address
907 INMAN RD, MEMPHIS, TN 38111-3009
(901) 791-6041
Mailing address
907 INMAN RD, MEMPHIS, TN 38111-3009
(901) 791-6041
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/29/2021
Last updated
04/29/2021
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