Provider Demographics
NPI:1962797399
Name:GENERATIONS GAITHIER MENTAL HEALTH
Entity type:Organization
Organization Name:GENERATIONS GAITHIER MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.P.N.
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:931-528-8593
Mailing Address - Street 1:375 NORROD LN
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-5485
Mailing Address - Country:US
Mailing Address - Phone:931-787-0328
Mailing Address - Fax:
Practice Address - Street 1:1080 NEAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0942
Practice Address - Country:US
Practice Address - Phone:931-528-8593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000071144261QM0801X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility