Organization
CLC OF FULTON, LLC
Active
Other names
Courtyards 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
907 E WALKER ST, FULTON, MS 38843-8954
(662) 862-6140
(662) 862-6143
Mailing address
PO BOX 69, P.O. BOX 69, FULTON, MS 38843-0069
(662) 680-3148
(662) 680-2659
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
768
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230184
—
MS
Enumeration date
10/25/2005
Last updated
01/28/2008
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