Provider Demographics
NPI:1104875764
Name:JEWISH FAMILY SERVICE INC
Entity type:Organization
Organization Name:JEWISH FAMILY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-767-8511
Mailing Address - Street 1:6560 POPLAR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3656
Mailing Address - Country:US
Mailing Address - Phone:901-767-8511
Mailing Address - Fax:901-763-2348
Practice Address - Street 1:6560 POPLAR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3656
Practice Address - Country:US
Practice Address - Phone:901-767-8511
Practice Address - Fax:901-763-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3007926OtherBLUE CROSS BLUE SHIELD
TN3719934Medicaid
3719934Medicare UPIN