Provider Demographics
NPI:1316317407
Name:RHA HEALTH SERVICES TN, LLC
Entity type:Organization
Organization Name:RHA HEALTH SERVICES TN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-692-5555
Mailing Address - Street 1:468 HALLE PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7089
Mailing Address - Country:US
Mailing Address - Phone:901-692-5555
Mailing Address - Fax:901-692-5561
Practice Address - Street 1:5050 POPLAR AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-0101
Practice Address - Country:US
Practice Address - Phone:901-767-1455
Practice Address - Fax:901-767-1409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHA HEALTH SERVICES TN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000012407320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities