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General NPI Number Information
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NPI Number | 1235676156
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Entity Type | Organization
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Legal Business Name | CLC OF HARRIMAN, LLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 257 PATTON LN
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City | HARRIMAN
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State | TN
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Zip | 37748-8618
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Country | US
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Telephone | 865-354-3941
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3667
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City | TUPELO
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State | MS
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Zip | 38803-3667
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Country | US
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Telephone | 662-680-3148
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DOUGLAS M WRIGHT JR.
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Credential |
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Telephone | 662-680-3148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 212
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 212
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License Number State | TN
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