Provider Demographics
NPI:1689674368
Name:LA PALOMA TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:LA PALOMA 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 1:2009 LAMAR AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-2138
Practice Address - Country:US
Practice Address - Phone:615-345-3217
Practice Address - Fax:615-373-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI 2(14)M2-077-9751261QM0801X
TNL 2(14)M3-017-6472261QM0850X
TN0000000109261QR0405X, 324500000X
TN0000000032261QR0405X
TNL000000010053320800000X
TNL 217-017-6471323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3105734OtherBCBST PROVIDER ID
TN444645Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
TN444647Medicare Oscar/Certification