Organization
EXTENDIMNG HEARTS HHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYOSHA JOHNSON (OWNER)
(901) 462-1775
Entity
Organization
Contact information
Practice address
700 PARKDALE DR, MEMPHIS, TN 38116-6212
(901) 462-1775
Mailing address
700 PARKDALE DR, MEMPHIS, TN 38116-6212
(901) 462-1775
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
115005378
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009180
—
TN
Enumeration date
11/12/2015
Last updated
11/12/2015
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