Provider Demographics
NPI:1912509407
Name:901 IN HOME CARE L.L.C.
Entity Type:Organization
Organization Name:901 IN HOME CARE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-221-2991
Mailing Address - Street 1:4955 GERTRUDE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-5753
Mailing Address - Country:US
Mailing Address - Phone:901-221-2991
Mailing Address - Fax:
Practice Address - Street 1:2502 MOUNT MORIAH RD STE H234
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1515
Practice Address - Country:US
Practice Address - Phone:901-221-2991
Practice Address - Fax:901-339-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health