Provider Demographics
NPI:1558016394
Name:PARK CENTER
Entity Type:Organization
Organization Name:PARK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-242-3576
Mailing Address - Street 1:1935 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3997
Mailing Address - Country:US
Mailing Address - Phone:615-242-3576
Mailing Address - Fax:
Practice Address - Street 1:1019 IVERSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-3013
Practice Address - Country:US
Practice Address - Phone:615-242-3576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-21
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness