Mid South Residential Care Center

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

I000000007899 Issued in TN

Legal business name

MID SOUTH RESIDENTIAL CARE CENTER

Practice address

1137 Breedlove St
Memphis, TN 38107-2101

Phone

(901) 314-0146

NPI assigned

Jan 13, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gwendolyn Clark

Title

Administrator

Phone

(901) 314-0146

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294876800000",
    "number": "1265737795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 280422",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38107",
            "telephone_number": "901-314-0146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1137 BREEDLOVE ST",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381072101",
            "telephone_number": "901-314-0146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID SOUTH RESIDENTIAL CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-13",
        "last_updated": "2011-01-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "901-314-0146"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TN",
            "license": "I000000007899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle James Family Care, PLLC
• Mid South Ambulatory Services, LLC
• Mid South Medical Associates
• Mid South Psychiatry, PLLC
• Mid South Regional Thoracic Center, LLC
• Mid South Senior Care, LLC
• Mid South Supportive Living, LLC
• Mid South Vascular Clinic
• Mid-South ABA Therapy
• Mid-South Area Residential Services

• All providers in Memphis, TN
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.