Provider Demographics
NPI:1386189066
Name:MID-SOUTH HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:MID-SOUTH HOME HEALTH SERVICES, LLC
Other - Org Name:BRIGHTSTAR CARE OF MEMPHIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-472-4100
Mailing Address - Street 1:5384 POPLAR AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3656
Mailing Address - Country:US
Mailing Address - Phone:901-472-4100
Mailing Address - Fax:866-436-9785
Practice Address - Street 1:5384 POPLAR AVE STE 340
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3656
Practice Address - Country:US
Practice Address - Phone:901-472-4100
Practice Address - Fax:866-436-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNL000000032055OtherTN DEPT. OF MENTAL HEALTH & SUBSTANCE ABUSE SERVICES LICENSE
TNI000000019423OtherPERSONAL SUPPORT SERVICES AGENCY