Organization
MINNOLA RESIDENTIAL CARE SERVICES,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERETHRA HARRIS (OWNER/DIRECTOR)
(901) 857-6635
Entity
Organization
Contact information
Practice address
4264 GENYTH AVE, MEMPHIS, TN 38128-3212
(901) 857-6635
Mailing address
4264 GENYTH AVE, MEMPHIS, TN 38128-3212
(901) 857-6635
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
1000000018260
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q021859
—
TN
Enumeration date
06/23/2016
Last updated
06/23/2016
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