Provider Demographics
NPI:1770684342
Name:MID-SOUTH HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:MID-SOUTH HEALTH SERVICES, LLC
Other - Org Name:ASHTON PLACE HEALTH & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-478-5953
Mailing Address - Street 1:485 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-5541
Mailing Address - Country:US
Mailing Address - Phone:423-478-5953
Mailing Address - Fax:
Practice Address - Street 1:3030 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3508
Practice Address - Country:US
Practice Address - Phone:901-458-1146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000252314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440442Medicaid
TN0445118Medicaid
TN445118Medicare Oscar/Certification