Provider Demographics
NPI:1730487026
Name:MGWARREN ENTERPRISES LLC
Entity Type:Organization
Organization Name:MGWARREN ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-713-4628
Mailing Address - Street 1:237 CASTLEWOOD DR STE H
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5166
Mailing Address - Country:US
Mailing Address - Phone:615-713-4628
Mailing Address - Fax:615-848-6820
Practice Address - Street 1:237 CASTLEWOOD DR STE H
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5166
Practice Address - Country:US
Practice Address - Phone:615-713-4628
Practice Address - Fax:615-848-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000008242253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNL000000008242OtherSTATE OF TENNESSEE DEPARTMENT OF MENTAL HEALTH LICENSE