NPIMap

Organization Active NPI

Shelby Residential & Vocational Services, Inc.

Doing business as Sandwick

  • Intellectual Disabilities Intermediate Care Facility
  • Memphis, TN
National Provider Identifier
1043467103
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
L323-067-6620 Issued in TN
Legal business name
SHELBY RESIDENTIAL & VOCATIONAL SERVICES, INC.
Doing business as
Sandwick
Practice address
3250 Sandwick Rd
Memphis, TN 38128-4154
Phone
(901) 357-0994
Fax
(901) 312-9906
NPI assigned
Aug 20, 2008
Last updated
May 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SHELBY RESIDENTIAL & VOCATIONAL SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shannon Durbin
Title
Executive Director
Phone
(901) 312-6845

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-067-6620 TN Primary

Addresses

Primary practice location

3250 Sandwick Rd
Memphis, TN 38128-4154

Mailing address

3971 Knight Arnold Rd
Memphis, TN 38118-3004
Phone (901) 869-7787

Other names 1

  • Sandwick Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043467103. Details of each certification follow.

  • CCN 44G059 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 44G059

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SANDWICK HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 5, 1992
Last certification
Aug 12, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
3250 Sandwick
Memphis, TN 38128

National Provider Directory

National Provider Directory
Tax ID family
Shelby Residential V9 organizations share this tax ID, including this one
Part of
Shelby Residential V

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3250 Sandwick Rd
Memphis, TN 38128
Phone (901) 357-0994

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1043467103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3971 KNIGHT ARNOLD RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381183004",
            "telephone_number": "901-869-7787",
            "fax_number": "901-322-6391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 SANDWICK RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381284154",
            "telephone_number": "901-357-0994",
            "fax_number": "901-312-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY RESIDENTIAL & VOCATIONAL SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHELBY RESIDENTIAL & VOCATIONAL SERVICES, INC.",
        "enumeration_date": "2008-08-20",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "DURBIN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "901-312-6845"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-067-6620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandwick",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sandwick",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.