NPI 1265737795

Mid South Residential Care Center

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Memphis, TN

Practice location

Address: 1137 Breedlove St, Memphis, TN 38107-2101
Phone: (901) 314-0146
Mailing address: P.O. Box 280422, Memphis, TN 38107

Authorised official

Name: Gwendolyn Clark
Title: Administrator
Phone: (901) 314-0146

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence I000000007899 (TN)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Tennessee →

Registry record

NPI: 1265737795
Entity type: Organization
NPI issued: 13 Jan 2011
Record last updated: 13 Jan 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.