Provider Demographics
NPI:1891145678
Name:COMMUNITY DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:COMMUNITY DEVELOPMENT CENTER
Other - Org Name:CHILD DEVELOPMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-684-8681
Mailing Address - Street 1:113 EAGLETTE WAY
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-9263
Mailing Address - Country:US
Mailing Address - Phone:931-684-8681
Mailing Address - Fax:931-684-9431
Practice Address - Street 1:1600 JASON MAXWELL BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2018
Practice Address - Country:US
Practice Address - Phone:931-359-1197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty