Provider Demographics
NPI:1376965210
Name:LETCHWORTH ELDER CARE LLC
Entity Type:Organization
Organization Name:LETCHWORTH ELDER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LETCHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:901-413-9426
Mailing Address - Street 1:PO BOX 381105
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1105
Mailing Address - Country:US
Mailing Address - Phone:901-413-9426
Mailing Address - Fax:
Practice Address - Street 1:3030 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3508
Practice Address - Country:US
Practice Address - Phone:901-413-9426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty