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Organization
MIDSOUTH RESIDENTIAL CARE CENTER,INC.
Active
Organization
MIDSOUTH RESIDENTIAL CARE CENTER,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWEN B CLARK (ADMINISTRATOR)
(901) 314-0146
Entity
Organization
Contact information
Practice address
1137 BREEDLOVE ST, MEMPHIS, TN 38107-2101
(901) 314-0146
Mailing address
PO BOX 280422, MEMPHIS, TN 38168-0422
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
L000000003760
TN
Other
Enumeration date
12/10/2009
Last updated
12/10/2009
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