Organization
CLC OF WHITEHAVEN, LLC
Active
Other names
Whitehaven 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
1076 CHAMBLISS RD, MEMPHIS, TN 38116-6381
(901) 396-8470
(901) 398-0271
Mailing address
PO BOX 161000, MEMPHIS, TN 38186-1000
(901) 396-8470
(901) 398-0271
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000258
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
744-0205
—
TN
Enumeration date
10/26/2005
Last updated
01/28/2008
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