MIDSOUTH RESIDENTIAL CARE CENTER,INC. (NPI# 1528397189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528397189 |
| Entity Type | Organization |
| Organization Name | MIDSOUTH RESIDENTIAL CARE CENTER,INC. |
| Practice Address |
1137 Breedlove St Memphis TN 38107-2101 |
| Mailing Address |
Po Box 280422 Memphis TN 38168-0422 |
| Practice Telephone | 9013140146 |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2009-12-10 |
| Authorized Official Name | GWEN B CLARK (ADMINISTRATOR) |
| Authorized Official Telephone | 9013140146 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | L000000003760 | TN | Residential Treatment Facilities |
| Street Address |
1137 BREEDLOVE ST |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38107-2101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265737795 | Mid South Residential Care Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1137 Breedlove St, Memphis, TN 38107-2101 | 2011-01-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346801925 | Sarah E. Stevenson | Respiratory Therapist, Certified | 236 Caldwell Ave., Memphis, TN 38107 | 2019-06-25 |
| 1235516097 | Behavioral Healthcare Center At Memphis, Inc. | Psychiatric Hospital | 1505 N Second Street, Memphis, TN 38107 | 2015-04-30 |
| 1568732766 | Mary Geneva Scott | Pharmacist | 957 Elm Grove Cr, Collierville, TN 38107 | 2012-01-04 |
| 1053375634 | Harbor View Nursing and Rehabilitation Center Inc | Nursing Facility/Intermediate Care Facility | 1513 N 2nd St, Memphis, TN 38107 | 2006-04-12 |
| 1902289937 | Emily Williams | Speech-Language Pathologist | 1513 N 2nd St, Memphis, TN 38107-1003 | 2015-07-08 |
| 1043586498 | Jordan A Bunn | Occupational Therapist | 1513 N 2nd St, Memphis, TN 38107-1003 | 2012-03-30 |
| 1700186624 | Colleen M. Foeller | Occupational Therapy Assistant | 1513 N 2nd St, Memphis, TN 38107-1003 | 2010-10-26 |
| 1972818920 | Brian Matthew Defeo | Physical Therapist | 1513 N 2nd St, Memphis, TN 38107-1003 | 2010-08-15 |
| 1154635993 | Jonna Pfountz | Occupational Therapist | 1513 N 2nd St, Memphis, TN 38107-1003 | 2010-08-04 |
| 1891009643 | Montricia Renese Glenn | Occupational Therapist | 1513 N 2nd St, Memphis, TN 38107-1003 | 2010-08-04 |
| Find all providers in zip 38107 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629611637 | Calico Developmental Services Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3874 Viscount Ave Ste 7, Memphis, TN 38118-6000 | 2019-10-22 |
| 1841831005 | Whiting Young LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4034 Brompton Rd, Memphis, TN 38118-6717 | 2019-09-30 |
| 1093117665 | Hope for Tomorrow Center for Supportive &assisted Living | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1069 Mcevers Rd, Memphis, TN 38111-6579 | 2014-09-25 |
| 1487875837 | Allied Health Network | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3685 Cherry Rd, Memphis, TN 38118-6356 | 2007-05-02 |
| 1265737795 | Mid South Residential Care Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1137 Breedlove St, Memphis, TN 38107-2101 | 2011-01-13 |
| 1811146269 | Youth Dimensions, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3385 Austin Peay Hwy, Memphis, TN 38128-3810 | 2008-09-10 |
| 1699921155 | Taylor Brown Garden Healthcare LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 568 Poplar Ave, Memphis, TN 38105-4510 | 2008-08-14 |
| 1679604458 | Mid South Supportive Living, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2600 Poplar Ave, Suite 223, Memphis, TN 38112-3851 | 2007-03-07 |
| 1598809105 | Rha Community Homes, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5050 Poplar Ave, Suite 718, Memphis, TN 38157-0101 | 2007-02-16 |
| 1407998883 | Youth Villages | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 7426 Memphis Arlington Rd, Memphis, TN 38135-1908 | 2007-02-13 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.