Provider Demographics
NPI:1164803623
Name:DANDELION DIVERSIFIED CARE
Entity Type:Organization
Organization Name:DANDELION DIVERSIFIED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-406-8797
Mailing Address - Street 1:8295 TOURNAMENT DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8906
Mailing Address - Country:US
Mailing Address - Phone:469-406-8797
Mailing Address - Fax:
Practice Address - Street 1:8295 TOURNAMENT DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8906
Practice Address - Country:US
Practice Address - Phone:469-406-8797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN000068705261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local