Provider Demographics
NPI:1114404530
Name:PB OUTPATIENT SERVICES TENNESSEE, LLC
Entity Type:Organization
Organization Name:PB OUTPATIENT SERVICES TENNESSEE, LLC
Other - Org Name:THE RANCH TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SASSERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-994-8001
Mailing Address - Street 1:PO BOX 207816
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7816
Mailing Address - Country:US
Mailing Address - Phone:847-329-4100
Mailing Address - Fax:847-329-4900
Practice Address - Street 1:6275 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:NUNNELLY
Practice Address - State:TN
Practice Address - Zip Code:37137-2523
Practice Address - Country:US
Practice Address - Phone:931-729-9728
Practice Address - Fax:931-729-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility