Healthcare Provider Details

I. General information

NPI: 1306321179
Provider Name (Legal Business Name): YARROW LODGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10677 N 48TH STREET
AUGUSTA MI
49012
US

IV. Provider business mailing address

1000 HEALTH PARK DR STE 400
BRENTWOOD TN
37027-5577
US

V. Phone/Fax

Practice location:
  • Phone: 269-282-7721
  • Fax:
Mailing address:
  • Phone: 615-386-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: EVP - CHIEF FINANCIAL OFFICER
Credential:
Phone: 610-382-3319