CLC of Whitehaven, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000258 Issued in TN

Legal business name

CLC OF WHITEHAVEN, LLC

Doing business as

Whitehaven Community Living Center

Practice address

1076 Chambliss Rd
Memphis, TN 38116-6381

Phone

(901) 396-8470

Fax

(901) 398-0271

NPI assigned

Oct 26, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Douglas M. Wright Jr.

Title

Managing Member

Phone

(662) 680-3148

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Whitehaven Community Living Center Doing business as

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1407846942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 161000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381861000",
            "telephone_number": "901-396-8470",
            "fax_number": "901-398-0271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1076 CHAMBLISS RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166381",
            "telephone_number": "901-396-8470",
            "fax_number": "901-398-0271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLC OF WHITEHAVEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "662-680-3148",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "744-0205",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whitehaven Community Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Memphis, TN
• Providers in Memphis, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; 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.