Provider Demographics
NPI:1912658261
Name:TRIPP'S RESIDENTIAL CARE HOME
Entity Type:Organization
Organization Name:TRIPP'S RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:901-289-2797
Mailing Address - Street 1:8840 RIVER RISE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-1628
Mailing Address - Country:US
Mailing Address - Phone:901-289-2797
Mailing Address - Fax:901-259-4441
Practice Address - Street 1:4536 WINDCHIME CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-1446
Practice Address - Country:US
Practice Address - Phone:901-289-2797
Practice Address - Fax:901-257-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care