Provider Demographics
NPI:1073299285
Name:BAILEY, DEMETRIA DENISE (ADMINISTRATOR RHA)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:DENISE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:ADMINISTRATOR RHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111076
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-1076
Mailing Address - Country:US
Mailing Address - Phone:901-340-4623
Mailing Address - Fax:
Practice Address - Street 1:2849 SHADY OAK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4656
Practice Address - Country:US
Practice Address - Phone:901-649-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003686311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home