Organization
CLC OF VAIDEN, LLC
Active
Other names
Vaiden Community Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS M. WRIGHT JR. (MANAGING MEMBER)
(662) 680-3148
Entity
Organization
Contact information
Practice address
868 MULBERRY ST, VAIDEN, MS 39176-5385
(662) 464-7714
(662) 464-7741
Mailing address
868 MULBERRY ST, VAIDEN, MS 39176-5385
(662) 464-7714
(662) 464-7741
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
947
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230151
—
MS
Enumeration date
10/27/2005
Last updated
01/15/2008
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