Organization
CLC OF HARRIMAN, LLC
Active
Other names
Renaissance Terrace
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS M WRIGHT JR. (MANAGING MEMBER)
(662) 680-3148
Entity
Organization
Contact information
Practice address
257 PATTON LN, HARRIMAN, TN 37748-8618
(865) 354-3941
Mailing address
PO BOX 3667, TUPELO, MS 38803-3667
(662) 680-3148
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
212
TN
314000000X
Skilled Nursing Facility
Primary
212
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q027302
—
TN
05
—
Q027303
—
TN
Enumeration date
01/30/2017
Last updated
05/26/2017
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