NPIMap

Organization Active NPI

Shelby Residential and Vocational Services

  • Intellectual Disabilities Intermediate Care Facility
  • Memphis, TN
National Provider Identifier
1194943514
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
L323-066-6232 Issued in TN
Legal business name
SHELBY RESIDENTIAL AND VOCATIONAL SERVICES
Practice address
3971 Knight Arnold Rd
Memphis, TN 38118-3004
Phone
(901) 869-7787
NPI assigned
Apr 23, 2007
Organization subpart
No

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) 821-1067

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-066-6232 TN Primary
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-066-6234 TN
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-066-6235 TN
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-066-6236 TN
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-066-6237 TN
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-066-6238 TN
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-066-6239 TN
Intellectual Disabilities Intermediate Care Facility 315P00000X L323-066-6244 TN

Addresses

Primary practice location

3971 Knight Arnold Rd
Memphis, TN 38118-3004

Mailing address

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

Other identifiers 8

IdentifierTypeStateIssuer
7447075MedicaidTN
7447076MedicaidTN
7447078MedicaidTN
7447077MedicaidTN
7447080MedicaidTN
7447079MedicaidTN
7447081MedicaidTN
7447082MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131106000970 TN Part B Supplier - Clinic/Group Practice 6608001227 Receives reassigned benefits from 1 practitioner
Practice locations: Memphis, TN

National Provider Directory

National Provider Directory
Tax ID family
Shelby Residential and Vocational Services9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

70 Timber Creek Dr
Ste 1
Cordova, TN 38018
Phone (901) 309-3077

3971 Knight Arnold Rd
Memphis, TN 38118
Phone (901) 312-6867

Ownership & related parties

Subparts reporting this organization as parent 8

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1194943514",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3971 KNIGHT ARNOLD RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381183004",
            "telephone_number": "901-869-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY RESIDENTIAL AND VOCATIONAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "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": "901-821-1067"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-066-6232",
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-066-6234",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-066-6235",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-066-6236",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-066-6237",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-066-6238",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-066-6239",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L323-066-6244",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447075",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447076",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447078",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447077",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447080",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447079",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447081",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447082",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.