Provider Demographics
NPI:1609053677
Name:CENTERSTONE
Entity Type:Organization
Organization Name:CENTERSTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:1931-722-3644
Mailing Address - Street 1:418 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-2629
Mailing Address - Country:US
Mailing Address - Phone:931-722-3644
Mailing Address - Fax:
Practice Address - Street 1:418 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2629
Practice Address - Country:US
Practice Address - Phone:931-722-3644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERSTONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-22
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management