Organization
OUTSTANDING SUPPORT SERVICES OF TN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELIQUE VATOCO DILWORTH MA (CHIEF EXECUTIVE OFFICER)
(901) 453-8838
Entity
Organization
Contact information
Practice address
3905 WILDLEAF DR, MEMPHIS, TN 38116-5516
(901) 453-8838
Mailing address
3905 WILDLEAF DR, MEMPHIS, TN 38116-5516
(901) 453-8838
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
03/29/2021
Last updated
02/05/2026
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