Provider Demographics
NPI:1316542012
Name:TENNESSEE RECOVERY CLINIC LLC
Entity Type:Organization
Organization Name:TENNESSEE RECOVERY CLINIC LLC
Other - Org Name:HAROLD CONNELL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLINICAL COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-278-4994
Mailing Address - Street 1:131 EDENWOLD RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2428
Mailing Address - Country:US
Mailing Address - Phone:615-600-5964
Mailing Address - Fax:
Practice Address - Street 1:131 EDENWOLD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2428
Practice Address - Country:US
Practice Address - Phone:615-600-5964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE RECOVERY CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-01
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000000025689OtherSTATE OF TN.