Provider Demographics
NPI:1356693931
Name:CENTERSTONE OF TENNESSEE
Entity type:Organization
Organization Name:CENTERSTONE OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY HELTH WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:DORRESS
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:GARBUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-887-9872
Mailing Address - Street 1:620 GALLATIN RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115
Mailing Address - Country:US
Mailing Address - Phone:615-598-3710
Mailing Address - Fax:
Practice Address - Street 1:620 GALLATIN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-598-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERSTONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN172V00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management