Organization
CLC OF BRUCE, LLC
Active
Other names
Bruce 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
176 HWY 9 SOUTH, BRUCE, MS 38915
(662) 412-5100
(662) 412-5122
Mailing address
PO BOX 1280, BRUCE, MS 38915-1280
(662) 412-5100
(662) 412-5122
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
667
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230046
—
MS
Enumeration date
11/19/2007
Last updated
11/19/2007
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