Organization
SUPPORTIVE SERVICES,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSIE M KEE RN (ADMINSTRATOR)
(901) 465-6474
Entity
Organization
Contact information
Practice address
5440 JERNIGAN DR, SOMERVILLE, TN 38068-6338
(901) 465-6474
(901) 465-6147
Mailing address
5440 JERNIGAN DR, SOMERVILLE, TN 38068-6338
(901) 465-6474
(901) 465-6147
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
0516064
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H445040
—
TN
Enumeration date
03/26/2007
Last updated
09/22/2008
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