Provider Demographics
NPI:1659693471
Name:LACY AND BRADFORD CARE FACILITY
Entity Type:Organization
Organization Name:LACY AND BRADFORD CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-372-3327
Mailing Address - Street 1:3533 KENDRICK RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38108-2026
Mailing Address - Country:US
Mailing Address - Phone:901-372-3327
Mailing Address - Fax:901-372-3327
Practice Address - Street 1:3533 KENDRICK RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38108-2026
Practice Address - Country:US
Practice Address - Phone:901-372-3327
Practice Address - Fax:901-372-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000005891305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization