Provider Demographics
NPI:1083226450
Name:UNIVERSAL SUPPORTIVE CARE
Entity Type:Organization
Organization Name:UNIVERSAL SUPPORTIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-729-6237
Mailing Address - Street 1:1840 PYRAMID PL STE 322
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-1703
Mailing Address - Country:US
Mailing Address - Phone:901-729-6237
Mailing Address - Fax:901-672-8520
Practice Address - Street 1:3592 KNIGHT ARNOLD RD STE 322
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2709
Practice Address - Country:US
Practice Address - Phone:901-729-6237
Practice Address - Fax:901-672-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1000000026916OtherSTATE LICENSE