Provider Demographics
NPI:1033988100
Name:CLARKSVILLE PSYCH HOSPITAL, LLC
Entity Type:Organization
Organization Name:CLARKSVILLE PSYCH HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-804-2526
Mailing Address - Street 1:PO BOX 1284
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1284
Mailing Address - Country:US
Mailing Address - Phone:812-670-4760
Mailing Address - Fax:812-725-8702
Practice Address - Street 1:1612 BLACKISTON VIEW DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2013
Practice Address - Country:US
Practice Address - Phone:812-670-4760
Practice Address - Fax:812-725-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health