Provider Demographics
NPI:1497458111
Name:CEDAR RECOVERY OF MIDDLE TENNESSEE, LLC
Entity Type:Organization
Organization Name:CEDAR RECOVERY OF MIDDLE TENNESSEE, LLC
Other - Org Name:CEDARRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-680-0110
Mailing Address - Street 1:5000 CROSSINGS CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8591
Mailing Address - Country:US
Mailing Address - Phone:615-288-1103
Mailing Address - Fax:615-549-7044
Practice Address - Street 1:1405 W BADDOUR PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2595
Practice Address - Country:US
Practice Address - Phone:615-257-6844
Practice Address - Fax:615-549-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy