Provider Demographics
NPI:1467092932
Name:MSHN ENTERPRISES LLC
Entity type:Organization
Organization Name:MSHN ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-410-9062
Mailing Address - Street 1:2057 FLETCHER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-7059
Mailing Address - Country:US
Mailing Address - Phone:901-825-8972
Mailing Address - Fax:901-729-6169
Practice Address - Street 1:2056 FLETCHER CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-7060
Practice Address - Country:US
Practice Address - Phone:901-410-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7544Medicaid
TNI000000031865OtherTDMHS