1689674368 NPI number — LA PALOMA TREATMENT CENTER, LLC

Table of content: (NPI 1689674368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689674368 NPI number — LA PALOMA TREATMENT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA PALOMA TREATMENT CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689674368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 HEALTH PARK DRIVE
Provider Second Line Business Mailing Address:
BUILDING THREE, SUITE 400
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-386-7255
Provider Business Mailing Address Fax Number:
615-645-7445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2009 LAMAR AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38114-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-345-3217
Provider Business Practice Location Address Fax Number:
615-373-4656
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP-CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
610-382-3319

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  I 2(14)M2-077-9751 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: L 2(14)M3-017-6472 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 0000000109 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 0000000032 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , with the licence number: L000000010053 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , with the licence number: L 217-017-6471 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 0000000109 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3105734 . This is a "BCBST PROVIDER ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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