Provider Demographics
NPI:1427280569
Name:SUPPORT SOLUTIONS OF TENNESSEE
Entity type:Organization
Organization Name:SUPPORT SOLUTIONS OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:VATOCO
Authorized Official - Last Name:DILWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:901-383-9193
Mailing Address - Street 1:5909 SHELBY OAKS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7318
Mailing Address - Country:US
Mailing Address - Phone:901-383-9193
Mailing Address - Fax:901-383-9195
Practice Address - Street 1:5909 SHELBY OAKS DR STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7318
Practice Address - Country:US
Practice Address - Phone:901-383-9193
Practice Address - Fax:901-383-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 385HR2060X
TNPSS0000000274251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251C00000XAgenciesDay Training, Developmentally Disabled Services