Organization
COMMUNITY TRANSITION NURSE CARE MANAGER, LLC
Active
Other names
Shephard Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
ADDIE MARCHANT (OWNER/CEO)
(901) 550-1486
Entity
Organization
Contact information
Practice address
3238 PLAYERS CLUB CIR STE 58&59, MEMPHIS, TN 38125-8843
(901) 869-5744
(901) 794-4128
Mailing address
4405 TIMBER JUMP, MEMPHIS, TN 38141-7395
(901) 550-1486
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
1000000016409
TN
261QP2300X
Primary Care Clinic/Center
—
—
363L00000X
Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q013486
—
TN
Enumeration date
06/10/2015
Last updated
08/04/2022
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