Active NPI
Midsouth Residential Care Center,Inc.
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Memphis, TN
National Provider Identifier
1528397189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- License
- L000000003760
- Legal business name
- MIDSOUTH RESIDENTIAL CARE CENTER,INC.
- Practice address
- 1137 Breedlove St
Memphis, TN 38107-2101 - Phone
- (901) 314-0146
- NPI assigned
- Dec 10, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gwen B Clark
- Title
- Administrator
- Phone
- (901) 314-0146
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | L000000003760 | TN | Primary |
Addresses
Primary practice location
1137 Breedlove St
Memphis, TN 38107-2101
Mailing address
PO Box 280422
Memphis, TN 38168-0422
National Provider Directory
National Provider Directory- Tax ID family
- Bonds Care Home Inc 2
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- In Home Supportive Care Agency
- Memphis, TN
- NPI 1770818718
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260403200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1260403200000",
"number": "1528397189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 280422",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381680422"
},
{
"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": "MIDSOUTH RESIDENTIAL CARE CENTER,INC.",
"organizational_subpart": "NO",
"enumeration_date": "2009-12-10",
"last_updated": "2009-12-10",
"status": "A",
"authorized_official_last_name": "CLARK",
"authorized_official_first_name": "GWEN",
"authorized_official_middle_name": "B",
"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": "L000000003760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
- Midsouth Mental Health LLC
- Midsouth Mental Health Services, Inc
- Midsouth Neurology Clinic PLLC
- Midsouth Neuropathy Treatment Center
- Midsouth Primary Care PC
- Midsouth Sleep Diagnostic Center Inc (American Sleep Medicine)
- Midsouth Therapy Group
- Midsouth Vision Center
- Midtown Center for Health and Rehabilitation, LLC (Midtown Center For Health and Rehabilitation)
- Midtown Center for Rehabilitation and Healing, LLC (Midtown Center For Rehabilitation and Healing)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.