Provider Demographics
NPI:1154793727
Name:YOUR COMMUNITY HEALTH & WELLNESS
Entity type:Organization
Organization Name:YOUR COMMUNITY HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-821-5835
Mailing Address - Street 1:1087 ALICE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-6543
Mailing Address - Country:US
Mailing Address - Phone:901-271-5379
Mailing Address - Fax:901-261-6144
Practice Address - Street 1:1087 ALICE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-6543
Practice Address - Country:US
Practice Address - Phone:901-271-5379
Practice Address - Fax:901-261-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty