Provider Demographics
NPI:1699040253
Name:CENTERSTONE
Entity Type:Organization
Organization Name:CENTERSTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRISIS CARE CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:MARQUEZ
Authorized Official - Last Name:JESZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-463-6600
Mailing Address - Street 1:7308 SMOKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37013-6803
Mailing Address - Country:US
Mailing Address - Phone:615-206-7875
Mailing Address - Fax:615-206-7875
Practice Address - Street 1:7308 SMOKEY HILL RD
Practice Address - Street 2:
Practice Address - City:CANE RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37013-6803
Practice Address - Country:US
Practice Address - Phone:615-206-7875
Practice Address - Fax:615-206-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness