Provider Demographics
NPI:1356676787
Name:RHA TRENTON MR INC.
Entity Type:Organization
Organization Name:RHA TRENTON MR INC.
Other - Org Name:89 WINDALE DR.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-855-0537
Mailing Address - Street 1:2055 US HIGHWAY 45 BYP S
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3501
Mailing Address - Country:US
Mailing Address - Phone:731-855-0537
Mailing Address - Fax:731-855-1257
Practice Address - Street 1:89 WINDALE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6010
Practice Address - Country:US
Practice Address - Phone:731-855-0537
Practice Address - Fax:731-855-1257
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHA TRENTON MR INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities