Provider Demographics
NPI:1639804636
Name:OPEN HEART COMMUNITY FOUNDATION
Entity Type:Organization
Organization Name:OPEN HEART COMMUNITY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSSA
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LASHAY
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSSA
Authorized Official - Phone:901-409-9740
Mailing Address - Street 1:5363 RAVENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4430
Mailing Address - Country:US
Mailing Address - Phone:901-409-1228
Mailing Address - Fax:
Practice Address - Street 1:1981 KANSAS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-1968
Practice Address - Country:US
Practice Address - Phone:901-409-1228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility