Provider Demographics
NPI:1174838882
Name:MID-SOUTH AREA RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:MID-SOUTH AREA RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-833-1298
Mailing Address - Street 1:5830 MOUNT MORIAH RD STE 22
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-1628
Mailing Address - Country:US
Mailing Address - Phone:901-363-6273
Mailing Address - Fax:901-363-6168
Practice Address - Street 1:5830 MOUNT MORIAH RD STE 22
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1628
Practice Address - Country:US
Practice Address - Phone:901-363-6273
Practice Address - Fax:901-363-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care