Provider Demographics
NPI:1740990795
Name:HOME OPPORTUNITY PLACEMENT ENVIRONMENT 4 ASSISTANT LIVING CARE LLC
Entity type:Organization
Organization Name:HOME OPPORTUNITY PLACEMENT ENVIRONMENT 4 ASSISTANT LIVING CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-315-8135
Mailing Address - Street 1:PO BOX 27473
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38167-0473
Mailing Address - Country:US
Mailing Address - Phone:901-315-8135
Mailing Address - Fax:901-255-2609
Practice Address - Street 1:3165 OVERTON CROSSING ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6522
Practice Address - Country:US
Practice Address - Phone:901-572-1759
Practice Address - Fax:901-255-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care