Provider Demographics
NPI:1992403547
Name:EPIPHANY WELLNESS TENNESSEE LLC
Entity type:Organization
Organization Name:EPIPHANY WELLNESS TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-353-1410
Mailing Address - Street 1:145 ANDERSON LN STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3915
Mailing Address - Country:US
Mailing Address - Phone:615-490-9263
Mailing Address - Fax:772-873-9997
Practice Address - Street 1:145 ANDERSON LN STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3915
Practice Address - Country:US
Practice Address - Phone:615-490-9263
Practice Address - Fax:772-873-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder