OrganizationActive
Midsouth Residential Care Center,inc.
NPI 1528397189 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Memphis, TN
Provider details
- NPI number
- 1528397189
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Gwen Clark, Administrator(901) 314-0146
- License
- L000000003760 (TN)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense L000000003760 (TN)
Residential Treatment Facilities
Practice location
1137 Breedlove St
Memphis, TN 38107-2101
Phone: (901) 314-0146
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 280422
Memphis, TN 38168-0422
Registry dates
- Enumerated
- 2009-12-10
- Last updated
- 2009-12-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.