| Organization Name: | MID SOUTH SENIOR CARE, LLC |
| NPI Number: | 1417353103 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL CHAD GILLILAND (PRESIDENT) |
| Mailing Address: | 5050 Poplar Ave Suite 2400 Memphis |
| State: | TN US |
| Postal Code: | 381570101 |
| Phone Number: | 9017667660 |
| Fax Number: | 9013281353 |
| NPI Enumeration Date: | 11/07/2014 |
| NPI Last Update Date: | 11/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | L000000013736 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |