Provider Demographics
NPI:1780004432
Name:STEPPINGSTONE RETREAT FOR ENHANCED LIVING LLC
Entity Type:Organization
Organization Name:STEPPINGSTONE RETREAT FOR ENHANCED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-775-3618
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-0733
Mailing Address - Country:US
Mailing Address - Phone:423-775-3618
Mailing Address - Fax:423-775-3618
Practice Address - Street 1:781 SUNSET DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5634
Practice Address - Country:US
Practice Address - Phone:423-775-3618
Practice Address - Fax:423-775-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0001746261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)