Provider Demographics
NPI:1033801279
Name:THE FARLEY CENTER
Entity Type:Organization
Organization Name:THE FARLEY CENTER
Other - Org Name:IRON BRIDGE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:MANGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-637-7157
Mailing Address - Street 1:6701 COURTYARD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1430
Mailing Address - Country:US
Mailing Address - Phone:615-637-5157
Mailing Address - Fax:
Practice Address - Street 1:6701 COURTYAND RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831
Practice Address - Country:US
Practice Address - Phone:615-637-7157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE FARLEY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty