Provider Demographics
NPI:1164030656
Name:CLARKSVILLE ADDICTION RECOVERY
Entity Type:Organization
Organization Name:CLARKSVILLE ADDICTION RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-512-8998
Mailing Address - Street 1:1823 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4604
Mailing Address - Country:US
Mailing Address - Phone:931-919-2742
Mailing Address - Fax:931-919-2743
Practice Address - Street 1:1823 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4604
Practice Address - Country:US
Practice Address - Phone:931-919-2742
Practice Address - Fax:931-919-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder