Provider Demographics
NPI:1588382469
Name:MY PARENTS PARADISE CAREHOME
Entity type:Organization
Organization Name:MY PARENTS PARADISE CAREHOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-281-2158
Mailing Address - Street 1:6407 W FORKED RIVER CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-6176
Mailing Address - Country:US
Mailing Address - Phone:901-281-2158
Mailing Address - Fax:
Practice Address - Street 1:3167 HILDA ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-3281
Practice Address - Country:US
Practice Address - Phone:901-281-2158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY PARENTS PARADISE CAREHOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home