Provider Demographics
NPI:1063934966
Name:SOBER LIVING OF TENNESSEE, INC
Entity type:Organization
Organization Name:SOBER LIVING OF TENNESSEE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-979-5158
Mailing Address - Street 1:269 W HUNT RD
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-1724
Mailing Address - Country:US
Mailing Address - Phone:931-979-5158
Mailing Address - Fax:
Practice Address - Street 1:402 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1900
Practice Address - Country:US
Practice Address - Phone:931-979-5158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI00000000004367OtherLICENSE