OrganizationActive
Mid South Supportive Living, LLC
NPI 1679604458 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Memphis, TN
Provider details
- NPI number
- 1679604458
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Authorized official
- David Gayden, Executive Director
- License
- L 3(20)M2-046-6201 (TN)
Practice location
2600 Poplar Ave
Suite 223
Memphis, TN 38112-3851
Phone: (901) 458-1181
Fax: (901) 324-9669
Mailing address
2600 Poplar Ave
Memphis, TN 38112-3851
Registry dates
- Enumerated
- 2007-03-07
- Last updated
- 2009-09-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.