Provider Demographics
NPI:1497316111
Name:COMMONS MID-SOUTH HOME CARE
Entity Type:Organization
Organization Name:COMMONS MID-SOUTH HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-480-8606
Mailing Address - Street 1:5395 FOX PLAZA DR STE 101J
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-1516
Mailing Address - Country:US
Mailing Address - Phone:901-480-8606
Mailing Address - Fax:901-249-8651
Practice Address - Street 1:5395 FOX PLAZA DR STE 101J
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1516
Practice Address - Country:US
Practice Address - Phone:901-480-8606
Practice Address - Fax:901-249-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care