Organization
CLC OF PASCAGOULA, LLC
Active
Other names
Plaza Community Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS M. WRIGHT SR. (MANAGING MEMBER)
(662) 680-3148
Entity
Organization
Contact information
Practice address
4403 HOSPITAL RD, PASCAGOULA, MS 39581-5335
(228) 762-8960
(228) 769-1820
Mailing address
4403 HOSPITAL RD, PASCAGOULA, MS 39581-5335
(228) 762-8960
(228) 769-1810
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
294
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230176
—
MS
Enumeration date
10/26/2005
Last updated
01/28/2008
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