Organization
CLC OF IUKA, LLC
Active
Other names
Tishomingo 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
1410 W QUITMAN ST, IUKA, MS 38852-1129
(662) 423-3422
(662) 423-5259
Mailing address
PO BOX 562, IUKA, MS 38852-0562
(662) 423-3422
(662) 423-5259
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
643
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230179
—
MS
Enumeration date
10/26/2005
Last updated
01/28/2008
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