Mid South Supportive Living, LLC

Primary specialty

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

License

L 3(20)M2-046-6201 Issued in TN

Legal business name

MID SOUTH SUPPORTIVE LIVING, LLC

Practice address

2600 Poplar Ave
Suite 223
Memphis, TN 38112-3851

Phone

(901) 458-1181

Fax

(901) 324-9669

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

Mr. David Gayden

Title

Executive Director

Phone

(901) 458-1181

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251936000000",
    "number": "1679604458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 POPLAR AVE",
            "address_2": "SUITE 223",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381123851",
            "telephone_number": "901-458-1181",
            "fax_number": "901-324-9669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 POPLAR AVE",
            "address_2": "SUITE 223",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381123851",
            "telephone_number": "901-458-1181",
            "fax_number": "901-324-9669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID SOUTH SUPPORTIVE LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2009-09-03",
        "status": "A",
        "authorized_official_last_name": "GAYDEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "901-458-1181",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TN",
            "license": "L 3(20)M2-046-6201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mid South Medical Associates
• Mid South Psychiatry, PLLC
• Mid South Regional Thoracic Center, LLC
• Mid South Residential Care Center
• Mid South Senior Care, LLC
• Mid South Vascular Clinic
• Mid-South ABA Therapy
• Mid-South Area Residential Services
• Mid-South Cardiovascular Center, LLC
• Mid-South Education and Behavior Solutions, LLC

• 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 Sep 3, 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.

Verify at the official NPI Registry.