Provider Demographics
NPI:1851678189
Name:JOEYS YACHT CLUB INC
Entity Type:Organization
Organization Name:JOEYS YACHT CLUB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-342-9590
Mailing Address - Street 1:3937 PEPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1677
Mailing Address - Country:US
Mailing Address - Phone:615-342-9590
Mailing Address - Fax:615-255-9967
Practice Address - Street 1:3937 PEPPERWOOD DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1677
Practice Address - Country:US
Practice Address - Phone:615-342-9590
Practice Address - Fax:615-255-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities