Provider Demographics
NPI: | 1952745127 |
---|---|
Name: | TENNESSEE LEARNING ACADEMY |
Entity type: | Organization |
Organization Name: | TENNESSEE LEARNING ACADEMY |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | SHARON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PAIGE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 901-273-4336 |
Mailing Address - Street 1: | PO BOX 753553 |
Mailing Address - Street 2: | |
Mailing Address - City: | MEMPHIS |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38175-3553 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 901-273-4336 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2491 JOY LN |
Practice Address - Street 2: | |
Practice Address - City: | MEMPHIS |
Practice Address - State: | TN |
Practice Address - Zip Code: | 38114-6088 |
Practice Address - Country: | US |
Practice Address - Phone: | 901-273-4336 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-04-18 |
Last Update Date: | 2013-04-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | SO/C0349 | 320800000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |