MEDICARE: BEHAVIORAL HEALTH OF ROCKY TOP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336I0012X	Institutional Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164012068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH OF ROCKY TOP, LLC

Provider Business Mailing Address
First Line	:	210 INDUSTRIAL PARK LN
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-2301
Country	:	US
Telephone Number	:	865-392-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 INDUSTRIAL PARK LN
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-2301
Country	:	US
Telephone Number	:	865-392-9200
Fax Number	:

Authorized Official
Title or Position	:	AR MANAGER
Name	:	JOHN HARRELL
Credential	:
Telephone Number	:	865-218-8966

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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