Organization
MID SOUTH RESIDENTIAL CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN CLARK (ADMINISTRATOR)
(901) 314-0146
Entity
Organization
Contact information
Practice address
1137 BREEDLOVE ST, MEMPHIS, TN 38107-2101
(901) 314-0146
Mailing address
P.O. BOX 280422, MEMPHIS, TN 38107
(901) 314-0146
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
I000000007899
TN
Other
Enumeration date
01/13/2011
Last updated
01/13/2011
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