Provider Demographics
NPI:1346474970
Name:MONUMENTAL REDEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:MONUMENTAL REDEVELOPMENT CORPORATION
Other - Org Name:VISION BEHAVIORAL HEALTH MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER AFFAIRS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MYRTLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-461-5368
Mailing Address - Street 1:1407 UNION AVE
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3627
Mailing Address - Country:US
Mailing Address - Phone:901-272-2622
Mailing Address - Fax:901-272-2602
Practice Address - Street 1:1407 UNION AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3627
Practice Address - Country:US
Practice Address - Phone:901-272-2622
Practice Address - Fax:901-272-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center