Midsouth Residential Care Center,inc.

NPI #1528397189 in Memphis, Tennessee

Provider Information

NPI Number: 1528397189
Entity Type: Organization
Organization Name: Midsouth Residential Care Center,inc.
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Dec 10, 2009
Last Updated: Dec 10, 2009

Practice Location

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

Authorized Official

Name: GWEN B 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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