Provider Demographics
NPI:1033216304
Name:SEXUAL ASSAULT CENTER
Entity Type:Organization
Organization Name:SEXUAL ASSAULT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:PENUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-259-9055
Mailing Address - Street 1:101 FRENCH LANDING DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1511
Mailing Address - Country:US
Mailing Address - Phone:615-259-9055
Mailing Address - Fax:615-244-6855
Practice Address - Street 1:101 FRENCH LANDING DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1511
Practice Address - Country:US
Practice Address - Phone:615-259-9055
Practice Address - Fax:615-244-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372472Medicare ID - Type UnspecifiedPROVIDER GROUP NUMBER