Healthcare Provider Details

I. General information

NPI: 1093705527
Provider Name (Legal Business Name): CLC OF WEST POINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 N ESHMAN AVE
WEST POINT MS
39773-5415
US

IV. Provider business mailing address

PO BOX 817
WEST POINT MS
39773-0817
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-6011
  • Fax: 662-494-6926
Mailing address:
  • Phone: 662-494-6011
  • Fax: 662-494-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number625
License Number StateMS

VIII. Authorized Official

Name: MR. DOUGLAS M. WRIGHT JR.
Title or Position: MANAGING MEMBER
Credential:
Phone: 662-680-3148