Organization
CLC OF HUMBOLDT, LLC
Active
Other names
Bailey Park 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
2400 E MITCHELL ST, HUMBOLDT, TN 38343-3036
(731) 784-5183
(731) 784-1562
Mailing address
2400 E MITCHELL ST, P.O. BOX 620, HUMBOLDT, TN 38343-3036
(731) 784-5183
(731) 784-1562
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000088
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
744-0208
—
TN
Enumeration date
10/25/2005
Last updated
01/28/2008
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