1750038386 NPI number — CEDAR RECOVERY CENTER OF MIDDLE TENNESSEE, LLC

Table of content: (NPI 1750038386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750038386 NPI number — CEDAR RECOVERY CENTER OF MIDDLE TENNESSEE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR RECOVERY CENTER OF MIDDLE TENNESSEE, 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:
1750038386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 CROSSINGS CIR STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT JULIET
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37122-8591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-288-1103
Provider Business Mailing Address Fax Number:
615-549-7044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 W BADDOUR PKWY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37087-2595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-994-1288
Provider Business Practice Location Address Fax Number:
615-547-4520
Provider Enumeration Date:
03/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BOND
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
615-680-0110

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com