Provider Demographics
NPI:1124495882
Name:CENTERSTONE OF TENNESSEE
Entity type:Organization
Organization Name:CENTERSTONE OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOBILE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPE
Authorized Official - Phone:615-870-8415
Mailing Address - Street 1:1101 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2650
Mailing Address - Country:US
Mailing Address - Phone:615-460-4100
Mailing Address - Fax:615-460-4104
Practice Address - Street 1:1101 6TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2650
Practice Address - Country:US
Practice Address - Phone:615-460-4100
Practice Address - Fax:615-460-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000011780251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3397960Medicaid
TN62-1674308OtherPROVIDER ENTITY TIN