Healthcare Provider Details

I. General information

NPI: 1518950609
Provider Name (Legal Business Name): MEMPHIS RECOVERY CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N MONTGOMERY ST
MEMPHIS TN
38104-6931
US

IV. Provider business mailing address

219 N MONTGOMERY ST
MEMPHIS TN
38104-6931
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-7751
  • Fax:
Mailing address:
  • Phone: 901-272-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number0000000013
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number0000000015
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0000000014
License Number StateTN

VIII. Authorized Official

Name: MR. MICHAEL MCLOUGHLIN
Title or Position: CEO
Credential:
Phone: 901-272-7751