Organization
CLC OF JACKSON, LLC
Active
Other names
Pleasant Hills 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
1600 RAYMOND RD, JACKSON, MS 39204-4203
(601) 371-1700
(601) 371-1006
Mailing address
1600 RAYMOND RD, JACKSON, MS 39204-4203
(601) 371-1700
(601) 371-1006
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
612
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230178
—
MS
Enumeration date
10/28/2005
Last updated
08/22/2020
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