Provider Demographics
NPI:1598513475
Name:BRENDA GRACEFUL LIVING
Entity type:Organization
Organization Name:BRENDA GRACEFUL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-498-0844
Mailing Address - Street 1:6451 WELLS FARMS CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-0314
Mailing Address - Country:US
Mailing Address - Phone:901-270-9497
Mailing Address - Fax:
Practice Address - Street 1:3173 KIRBY WHITTEN RD STE 204
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2881
Practice Address - Country:US
Practice Address - Phone:901-498-0844
Practice Address - Fax:901-205-0794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRENDA GRACEFUL LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-07
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities