Provider Demographics
NPI:1174654743
Name:BAPTIST MEMORIAL HOME CARE INC
Entity Type:Organization
Organization Name:BAPTIST MEMORIAL HOME CARE INC
Other - Org Name:BAPTIST TRINITY HOMECARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP/ CLO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-227-5233
Mailing Address - Street 1:6141 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2179
Mailing Address - Country:US
Mailing Address - Phone:901-767-6767
Mailing Address - Fax:
Practice Address - Street 1:6141 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2179
Practice Address - Country:US
Practice Address - Phone:901-767-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST MEMORIAL HEALTH CARE CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000354251G00000X
TN0000000242251J00000X
TNL4380866324251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3874OtherTENNCARE PROV NUMBER MCO
TN0187373OtherTN BLUE CROSS
TN3874OtherTENNCARE PROV NUMBER MCO