Mid South Residential Care Center
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Memphis, TN. Organization (NPI-2).
NPI number1265737795
StatusActive
Last updated in NPPESJan 13, 2011
Details
- NPI
- 1265737795
- Entity type
- Organization (NPI-2)
- Legal business name
- Mid South Residential Care Center
- Organization subpart
- No
- Enumeration date
- Jan 13, 2011
- Last updated
- Jan 13, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | I000000007899 | TN | Yes |
Practice location
1137 Breedlove StMemphis, TN 38107-2101
Phone 901-314-0146
Mailing address
P.O. Box 280422Memphis, TN 38107
Phone 901-314-0146
Authorized official
Gwendolyn Clark
Administrator
9013140146
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