Provider Demographics
NPI:1659752103
Name:COMMUNITY TRANSITION NURSE CARE MANAGER, LLC
Entity Type:Organization
Organization Name:COMMUNITY TRANSITION NURSE CARE MANAGER, LLC
Other - Org Name:SHEPHARD PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-550-1486
Mailing Address - Street 1:4405 TIMBER JUMP
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-7395
Mailing Address - Country:US
Mailing Address - Phone:901-550-1486
Mailing Address - Fax:
Practice Address - Street 1:3238 PLAYERS CLUB CIR STE 58&59
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8843
Practice Address - Country:US
Practice Address - Phone:901-869-5744
Practice Address - Fax:901-794-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WC0400X, 251B00000X, 251E00000X, 261QP2300X, 363L00000X, 363LP2300X
TN1000000016409251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013486Medicaid