Provider Demographics
NPI:1700929205
Name:CUMBERLAND PLATEAU RECOVERY
Entity Type:Organization
Organization Name:CUMBERLAND PLATEAU RECOVERY
Other - Org Name:CUMBERLAND PLATEAU RECOVERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MA LADAC
Authorized Official - Phone:931-403-3577
Mailing Address - Street 1:550 NORTH CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570
Mailing Address - Country:US
Mailing Address - Phone:931-403-3577
Mailing Address - Fax:
Practice Address - Street 1:550 NORTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570
Practice Address - Country:US
Practice Address - Phone:931-403-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN553101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441089Medicaid