Healthcare Provider Details

I. General information

NPI: 1801345285
Provider Name (Legal Business Name): CEDAR RECOVERY CENTER OF MIDDLE TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 HATCHER LN
COLUMBIA TN
38401-4825
US

IV. Provider business mailing address

5000 CROSSINGS CIR STE 103
MOUNT JULIET TN
37122-8591
US

V. Phone/Fax

Practice location:
  • Phone: 931-948-8882
  • Fax: 931-223-8717
Mailing address:
  • Phone: 615-288-1103
  • Fax: 615-549-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BOND
Title or Position: OWNER
Credential:
Phone: 615-680-0110