Organization
GOODE PROVIDER
Active
Organization
GOODE PROVIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA MONTGOMERY (ADMINISTRATOR)
(346) 262-2669
Entity
Organization
Contact information
Practice address
2969 MOUNTAIN TERRACE ST, MEMPHIS, TN 38127-8335
(901) 821-1123
Mailing address
PO BOX 342322, BARTLETT, TN 38184-2322
(901) 230-2269
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/08/2018
Last updated
02/02/2024
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