Organization
CALICO DEVELOPMENTAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY BUCHANNON (EXECUTIVE DIRECTOR)
(404) 819-1611
Entity
Organization
Contact information
Practice address
3874 VISCOUNT AVE STE 7, MEMPHIS, TN 38118-6000
(615) 968-0447
(901) 417-8113
Mailing address
3874 VISCOUNT AVE STE 7, MEMPHIS, TN 38118-6000
(615) 968-0447
(901) 417-8113
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
10/22/2019
Last updated
10/22/2019
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