Provider Demographics
NPI:1659843092
Name:PROMISE ACADEMY SPRING HILL, INC
Entity Type:Organization
Organization Name:PROMISE ACADEMY SPRING HILL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-728-5858
Mailing Address - Street 1:650 NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5536
Mailing Address - Country:US
Mailing Address - Phone:901-728-5858
Mailing Address - Fax:901-531-6310
Practice Address - Street 1:3796 FRAYSER RALEIGH RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5235
Practice Address - Country:US
Practice Address - Phone:901-728-5858
Practice Address - Fax:901-531-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty