Provider Demographics
NPI:1619241643
Name:KINDRED PLACE, INC.
Entity Type:Organization
Organization Name:KINDRED PLACE, INC.
Other - Org Name:THE EXCHANGE CLUB FAMILY CENTER OF THE MID-SOUTH, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OF STAFF/INTERIM EXEC. DIR.
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEINERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-341-7778
Mailing Address - Street 1:2180 UNION AVE.
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4205
Mailing Address - Country:US
Mailing Address - Phone:901-276-2200
Mailing Address - Fax:901-276-6828
Practice Address - Street 1:2180 UNION AVE.
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4205
Practice Address - Country:US
Practice Address - Phone:901-276-2200
Practice Address - Fax:901-276-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSO10823A251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health