Mid South Residential Care Center

NPI #1265737795 in Memphis, Tennessee

Provider Information

NPI Number: 1265737795
Entity Type: Organization
Organization Name: Mid South Residential Care Center
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jan 13, 2011
Last Updated: Jan 13, 2011

Practice Location

Address: 1137 BREEDLOVE ST
City: Memphis
State: Tennessee
ZIP Code: 38107-2101
Phone: (901) 314-0146

Authorized Official

Name: GWENDOLYN CLARK
Title: ADMINISTRATOR
Phone: (901) 314-0146

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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