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General NPI Number Information
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NPI Number | 1770684342
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Entity Type | Organization
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Legal Business Name | MID-SOUTH HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 3030 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38111-3508
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Country | US
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Telephone | 901-458-1146
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Fax |
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Provider Business Mailing Address
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Address Line | 485 CENTRAL AVE NE
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City | CLEVELAND
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State | TN
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Zip | 37311-5541
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Country | US
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Telephone | 423-478-5953
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JEFF CANTRELL
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Credential |
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Telephone | 423-478-5953
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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 | 0000000252
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License Number State | TN
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