Provider Demographics
NPI:1285238824
Name:RESURGENCE TENNESSEE, LLC
Entity type:Organization
Organization Name:RESURGENCE TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT #122999
Authorized Official - Phone:949-244-5481
Mailing Address - Street 1:3151 AIRWAY AVE STE M1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4626
Mailing Address - Country:US
Mailing Address - Phone:949-244-5481
Mailing Address - Fax:949-209-5490
Practice Address - Street 1:201 WILLIAM D JONES BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2730
Practice Address - Country:US
Practice Address - Phone:888-700-5053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124627443OtherFACILITY