Provider Demographics
NPI:1235651753
Name:LE DUJOUR H.E.R.O. VILLAGE OF THE MID-SOUTH, INC.
Entity Type:Organization
Organization Name:LE DUJOUR H.E.R.O. VILLAGE OF THE MID-SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VACHENZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRAW-MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-388-0140
Mailing Address - Street 1:3750 HACKS CROSS RD STE 102-218
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3750 HACKS CROSS RD STE 102-218
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2367
Practice Address - Country:US
Practice Address - Phone:662-388-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service