Organization
OUTSTANDING SUPPORT SERVICES OF TN
Active
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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