Provider Demographics
NPI:1013462050
Name:C.S. PATTERSON TRAINING & HABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:C.S. PATTERSON TRAINING & HABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-855-2316
Mailing Address - Street 1:1284 US HIGHWAY 45 BYP N
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-4005
Mailing Address - Country:US
Mailing Address - Phone:731-855-2316
Mailing Address - Fax:731-855-3608
Practice Address - Street 1:1284 US HIGHWAY 45 BYP N
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-4005
Practice Address - Country:US
Practice Address - Phone:731-855-2316
Practice Address - Fax:731-855-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL14219251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018339Medicaid