Provider Demographics
NPI:1366002305
Name:E3 COMMUNITY HEALTH/ ENGAGE. EDUCATE. EMPOWER. COMMUNITY HEALTH
Entity Type:Organization
Organization Name:E3 COMMUNITY HEALTH/ ENGAGE. EDUCATE. EMPOWER. COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-729-9767
Mailing Address - Street 1:5587 MURRAY AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0896
Mailing Address - Country:US
Mailing Address - Phone:901-729-9767
Mailing Address - Fax:
Practice Address - Street 1:5587 MURRAY AVE STE 205
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0896
Practice Address - Country:US
Practice Address - Phone:901-729-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty