OrganizationActive
Mid South Residential Care Center
NPI 1265737795 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Memphis, TN
Provider details
- NPI number
- 1265737795
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Gwendolyn Clark, Administrator(901) 314-0146
- License
- I000000007899 (TN)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense I000000007899 (TN)
Residential Treatment Facilities
Practice location
1137 Breedlove St
Memphis, TN 38107-2101
Phone: (901) 314-0146
Approximate (ZIP-level) locationGet directions
Mailing address
P.o. Box 280422
Memphis, TN 38107
Registry dates
- Enumerated
- 2011-01-13
- Last updated
- 2011-01-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.