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NPI Code Detail

MEDICARE: CLC OF BILOXI, LLC

MEDICARE: CLC OF BILOXI, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility462MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295725083
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLC OF BILOXI, LLC
Provider Business Mailing Address
First Line : 2279 ATKINSON RD
Second Line :
City : BILOXI
State : MS
Zip : 39531-2209
Country : US
Telephone Number : 228-388-1805
Fax Number : 228-388-9617
Provider Business Practice Location Address
First Line : 2279 ATKINSON RD
Second Line :
City : BILOXI
State : MS
Zip : 39531-2209
Country : US
Telephone Number : 228-388-1805
Fax Number : 228-388-9617
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. DOUGLAS M. WRIGHT JR.
Credential :
Telephone Number : 662-680-3148
Provider Enumeration Date : 10/24/2005
Last Update Date : 06/13/2016

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Directions to “CLC OF BILOXI, LLC ” Practice Location

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