Organization
J & J HABILITATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH WALLACE (CEO)
(786) 569-7649
Entity
Organization
Contact information
Practice address
4646 POPLAR AVE STE 440, MEMPHIS, TN 38117-4434
(786) 569-7649
Mailing address
934 DAVIS PKWY APT 24, FLORIDA CITY, FL 33034-3180
(786) 569-7649
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q061184
—
TN
Enumeration date
05/08/2020
Last updated
01/06/2021
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