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General NPI Number Information
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NPI Number | 1417353103
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Entity Type | Organization
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Legal Business Name | MID SOUTH SENIOR CARE, LLC
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 5050 POPLAR AVE SUITE 2400
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City | MEMPHIS
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State | TN
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Zip | 38157-0101
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Country | US
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Telephone | 901-766-7660
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Fax | 901-328-1353
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Provider Business Mailing Address
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Address Line | 5050 POPLAR AVE SUITE 2400
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City | MEMPHIS
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State | TN
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Zip | 38157-0101
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Country | US
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Telephone | 901-766-7660
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Fax | 901-328-1353
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL CHAD GILLILAND
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Credential |
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Telephone | 901-766-7660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | L000000013736
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License Number State | TN
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