Provider Demographics
NPI:1689345381
Name:ARBOR WELLNESS LLC
Entity Type:Organization
Organization Name:ARBOR WELLNESS LLC
Other - Org Name:ARBOR WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:ROUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-371-2495
Mailing Address - Street 1:370 CUMBERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-3170
Mailing Address - Country:US
Mailing Address - Phone:615-246-7275
Mailing Address - Fax:615-622-1168
Practice Address - Street 1:370 CUMBERLAND WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-3170
Practice Address - Country:US
Practice Address - Phone:615-246-7275
Practice Address - Fax:615-622-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1689841744OtherMEDICAL DIRECTOR NPI LISTED BELOW