Provider Demographics
NPI:1699921155
Name:TAYLOR BROWN GARDEN HEALTHCARE LLC
Entity type:Organization
Organization Name:TAYLOR BROWN GARDEN HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IVORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-527-2411
Mailing Address - Street 1:568 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4510
Mailing Address - Country:US
Mailing Address - Phone:901-527-2411
Mailing Address - Fax:901-527-2413
Practice Address - Street 1:568 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4510
Practice Address - Country:US
Practice Address - Phone:901-527-2411
Practice Address - Fax:901-527-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251E00000X, 302R00000X
TN1000000005282320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506990Medicaid