Provider Demographics
NPI:1144611377
Name:MISSIONARY HOMECARE AGENCY, LLC
Entity Type:Organization
Organization Name:MISSIONARY HOMECARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-949-2517
Mailing Address - Street 1:4384 STAGE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5794
Mailing Address - Country:US
Mailing Address - Phone:901-249-3931
Mailing Address - Fax:901-249-8134
Practice Address - Street 1:4384 STAGE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5794
Practice Address - Country:US
Practice Address - Phone:901-249-3931
Practice Address - Fax:901-249-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445667Medicaid