Provider Demographics
NPI:1881130557
Name:SHELBY COUNTY GOVERNMENT
Entity type:Organization
Organization Name:SHELBY COUNTY GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-222-4100
Mailing Address - Street 1:2670 UNION AVENUE EXT
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4426
Mailing Address - Country:US
Mailing Address - Phone:901-222-4100
Mailing Address - Fax:901-222-4199
Practice Address - Street 1:2670 UNION AVENUE EXT
Practice Address - Street 2:SUITE 1000
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4426
Practice Address - Country:US
Practice Address - Phone:901-222-4100
Practice Address - Fax:901-222-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445759Medicaid