Provider Demographics
NPI:1073554499
Name:THE DR. JAMES S. HAYES LIVING HEALTH CARE AGENCY, INC
Entity Type:Organization
Organization Name:THE DR. JAMES S. HAYES LIVING HEALTH CARE AGENCY, INC
Other - Org Name:FAMILY HOME HEALTH AGENCY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:KENDRICKS
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-946-9992
Mailing Address - Street 1:1324 MISSISSIPPI BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-4720
Mailing Address - Country:US
Mailing Address - Phone:901-946-9992
Mailing Address - Fax:901-946-5295
Practice Address - Street 1:1324 MISSISSIPPI BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-4720
Practice Address - Country:US
Practice Address - Phone:901-946-9992
Practice Address - Fax:901-946-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000229251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN447550Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER