Provider Demographics
NPI:1508161126
Name:RHATRENTON MR INC.
Entity Type:Organization
Organization Name:RHATRENTON MR INC.
Other - Org Name:195 TURNER'S LOOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-692-5555
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 1:195 TURNER'S LOOP
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343
Practice Address - Country:US
Practice Address - Phone:731-855-0537
Practice Address - Fax:731-855-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities