Provider Demographics
NPI:1558788802
Name:BLACK BEAR TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:BLACK BEAR TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP-CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-382-3319
Mailing Address - Street 1:1000 HEALTH PARK DRIVE
Mailing Address - Street 2:BUILDING THREE, SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-386-7255
Mailing Address - Fax:615-645-7445
Practice Address - Street 1:310 BLACK BEAR RDG
Practice Address - Street 2:
Practice Address - City:SAUTEE
Practice Address - State:GA
Practice Address - Zip Code:30571-3500
Practice Address - Country:US
Practice Address - Phone:470-539-6903
Practice Address - Fax:706-438-6876
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDATIONS RECOVERY NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-25
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA154208D324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility