Provider Demographics
NPI:1407025539
Name:SUPPORT SOLUTIONS OF THE MID-SOUTH
Entity Type:Organization
Organization Name:SUPPORT SOLUTIONS OF THE MID-SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:901-383-9193
Mailing Address - Street 1:5909 SHELBY OAKS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7317
Mailing Address - Country:US
Mailing Address - Phone:901-383-9193
Mailing Address - Fax:901-383-9195
Practice Address - Street 1:5909 SHELBY OAKS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7317
Practice Address - Country:US
Practice Address - Phone:901-383-9193
Practice Address - Fax:901-383-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL3(20)4M4-038-6644251S00000X
TNPSS0000000274253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care