Provider Demographics
NPI:1174033906
Name:BEHAVIORAL HEALTH OF ROCKY TOP, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH OF ROCKY TOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-218-8966
Mailing Address - Street 1:PO BOX 23376
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37933-1376
Mailing Address - Country:US
Mailing Address - Phone:865-218-8966
Mailing Address - Fax:
Practice Address - Street 1:210 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROCKY TOP
Practice Address - State:TN
Practice Address - Zip Code:37769-2301
Practice Address - Country:US
Practice Address - Phone:865-218-8966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital