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General NPI Number Information
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NPI Number | 1407846942
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Entity Type | Organization
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Legal Business Name | CLC OF WHITEHAVEN, LLC
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 1076 CHAMBLISS RD
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City | MEMPHIS
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State | TN
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Zip | 38116-6381
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Country | US
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Telephone | 901-396-8470
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Fax | 901-398-0271
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Provider Business Mailing Address
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Address Line | PO BOX 161000
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City | MEMPHIS
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State | TN
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Zip | 38186-1000
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Country | US
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Telephone | 901-396-8470
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Fax | 901-398-0271
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. 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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0000000258
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License Number State | TN
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